Muscle Strengthening and Return-to-exercise Criteria After Anterior Cruciate Ligament Reconstruction (ACLR)

NCT05814445 | Unknown

• 1 other identifier: 27/21
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior cruciate ligament injury is very common in recreational and elite athletes. It is considered the second most frequent pathology seeing in Sports Medicine Services. After the injury and ACLR, there is a marked decrease in the strength of the knee extensors/flexors muscles. Strength exercise programs are aimed at recovering strength and functionality, however, a low percentage of patients manage to achieve the optimal return-to-exercise criteria. Therefore, it is relevant to design and evaluate exercise programs that allow early recovery of muscle strength and knee functionality. The main purpose of this study is to investigate a neuromuscular exercise program compared with a standard institutional program in the recovery of the strength and functionality of the knee extensor/flexor muscles after ACLR.

Conditions

Anterior Cruciate Ligament Injuries

Outcome Measures

Primary Outcomes (4)

• Knee flexors muscle strength asymmetry

  The asymmetry will be calculated as the percentage of the peak knee flexor torque in the involved limb over the peak knee flexor torque in the uninvolved limb, multiplied by 100. Asymmetry % = (peak flexor torque involved limb/ peak flexor torque uninvolved limb) \*100

  22 weeks

• Knee extensors muscle strength asymmetry

  The asymmetry will be calculated as the percentage of the peak knee extensor torque in the involved limb over the peak knee extensor torque in the uninvolved limb, multiplied by 100. Asymmetry % = (peak extensor torque involved limb/peak extensor torque uninvolved limb)\*100

  22 weeks

• Hop distance asymmetry

  The asymmetry will be calculated as the percentage of the hop distance (one leg hop, triple hop, or cross-over hop) in the involved limb over the hop distance in the uninvolved limb, multiplied by 100. Asymmetry % = (hop distance involved limb/hop distance uninvolved limb)\*100

  22 weeks

• Agility T-test time

  The time will be determined with data obtained from T-test; the fastest time will be recorded.

  22 weeks

Secondary Outcomes (2)

• Leg muscle quality index (MQIleg)

  Baseline and 22 weeks

• Lysholm knee score

  Baseline and 22 weeks

Study Arms (2)

Neuromuscular exercise program

EXPERIMENTAL

Participants on a neuromuscular exercise program

Other: Neuromuscular exercise program

Institutional exercise program

ACTIVE COMPARATOR

Participants on an institutional exercise program

Other: Institutional exercise program

Interventions

Neuromuscular exercise program OTHER

Participants will complete a neuromuscular program during 22 weeks. The program consist of isotonic open and closed kinetic chain exercises for the hip and knee, and training to improve hip and knee muscles strength, proprioception, and core stability.

Neuromuscular exercise program

Institutional exercise program OTHER

Participants will complete an institutional exercise program during 22 weeks. The program consist of isotonic open and closed kinetic chain exercises for the hip and knee, and concentric and eccentric knee exercises.

Institutional exercise program

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• History of sports practice immediately prior to the injury
• Post-operated unilaterally for ACL with the hamstring autograft technique (semitendinosus-gracilis tendons),
• Full ranges of motion and no edema
• Body mass index \< 30.0 kg/mˆ2

You may not qualify if:

• Multi-ligament knee injuries,
• More than 12 months from the injury to surgery
• More than 8 months after surgery
• Uncompensated metabolic diseases
• Acute illnesses/infections under treatment

Sponsors & Collaborators

• Instituto Nacional de Rehabilitacion: lead

Study Sites (1)

National Institute of Rehabilitation

Mexico City, 14389, Mexico

RECRUITING

Related Publications (20)

• LaBella CR, Hennrikus W, Hewett TE; Council on Sports Medicine and Fitness, and Section on Orthopaedics. Anterior cruciate ligament injuries: diagnosis, treatment, and prevention. Pediatrics. 2014 May;133(5):e1437-50. doi: 10.1542/peds.2014-0623.

  PMID: 24777218 BACKGROUND

• van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MW. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016 Dec;50(24):1506-1515. doi: 10.1136/bjsports-2015-095898. Epub 2016 Aug 18.

  PMID: 27539507 BACKGROUND

• Thomas AC, Villwock M, Wojtys EM, Palmieri-Smith RM. Lower extremity muscle strength after anterior cruciate ligament injury and reconstruction. J Athl Train. 2013 Sep-Oct;48(5):610-20. doi: 10.4085/1062-6050-48.3.23. Epub 2013 Apr 18.

  PMID: 24067150 BACKGROUND

• Buckthorpe M, La Rosa G, Villa FD. RESTORING KNEE EXTENSOR STRENGTH AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CLINICAL COMMENTARY. Int J Sports Phys Ther. 2019 Feb;14(1):159-172.

  PMID: 30746302 BACKGROUND

• Palmieri-Smith RM, Lepley LK. Quadriceps Strength Asymmetry After Anterior Cruciate Ligament Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity. Am J Sports Med. 2015 Jul;43(7):1662-9. doi: 10.1177/0363546515578252. Epub 2015 Apr 16.

  PMID: 25883169 BACKGROUND

• Della Villa S, Boldrini L, Ricci M, Danelon F, Snyder-Mackler L, Nanni G, Roi GS. Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol. Sports Health. 2012 Jan;4(1):17-24. doi: 10.1177/1941738111417564.

  PMID: 23016064 BACKGROUND

• Souissi S, Wong del P, Dellal A, Croisier JL, Ellouze Z, Chamari K. Improving Functional Performance and Muscle Power 4-to-6 Months After Anterior Cruciate Ligament Reconstruction. J Sports Sci Med. 2011 Dec 1;10(4):655-64. eCollection 2011.

  PMID: 24149555 BACKGROUND

• Cavanaugh JT, Powers M. ACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep;10(3):289-296. doi: 10.1007/s12178-017-9426-3.

  PMID: 28791612 BACKGROUND

• Myer GD, Brent JL, Ford KR, Hewett TE. Real-time assessment and neuromuscular training feedback techniques to prevent ACL injury in female athletes. Strength Cond J. 2011 Jun 1;33(3):21-35. doi: 10.1519/SSC.0b013e318213afa8.

  PMID: 21643474 BACKGROUND

• Reid A, Birmingham TB, Stratford PW, Alcock GK, Giffin JR. Hop testing provides a reliable and valid outcome measure during rehabilitation after anterior cruciate ligament reconstruction. Phys Ther. 2007 Mar;87(3):337-49. doi: 10.2522/ptj.20060143. Epub 2007 Feb 20.

  PMID: 17311886 BACKGROUND

• Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med. 1991 Sep-Oct;19(5):513-8. doi: 10.1177/036354659101900518.

  PMID: 1962720 BACKGROUND

• Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11(0 11):S208-28. doi: 10.1002/acr.20632. No abstract available.

  PMID: 22588746 BACKGROUND

• Abrams GD, Harris JD, Gupta AK, McCormick FM, Bush-Joseph CA, Verma NN, Cole BJ, Bach BR Jr. Functional Performance Testing After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med. 2014 Jan 21;2(1):2325967113518305. doi: 10.1177/2325967113518305. eCollection 2014 Jan.

  PMID: 26535266 BACKGROUND

• Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016 Aug;50(15):946-51. doi: 10.1136/bjsports-2015-095908. Epub 2016 May 23.

  PMID: 27215935 BACKGROUND

• Schmitt LC, Paterno MV, Hewett TE. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012 Sep;42(9):750-9. doi: 10.2519/jospt.2012.4194. Epub 2012 Jul 19.

  PMID: 22813542 BACKGROUND

• Cristiani R, Mikkelsen C, Forssblad M, Engstrom B, Stalman A. Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3461-3470. doi: 10.1007/s00167-019-05396-4. Epub 2019 Feb 18.

  PMID: 30778627 BACKGROUND

• Daneshjoo A, Mokhtar A, Rahnama N, Yusof A. The effects of injury prevention warm-up programmes on knee strength in male soccer players. Biol Sport. 2013 Dec;30(4):281-8. doi: 10.5604/20831862.1077554. Epub 2013 Nov 25.

  PMID: 24795499 BACKGROUND

• Herman K, Barton C, Malliaras P, Morrissey D. The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med. 2012 Jul 19;10:75. doi: 10.1186/1741-7015-10-75.

  PMID: 22812375 BACKGROUND

• Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med. 2005 Jul;33(7):1003-10. doi: 10.1177/0363546504272261. Epub 2005 May 11.

  PMID: 15888716 BACKGROUND

• Sugimoto D, Myer GD, McKeon JM, Hewett TE. Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. Br J Sports Med. 2012 Nov;46(14):979-88. doi: 10.1136/bjsports-2011-090895. Epub 2012 Jun 28.

  PMID: 22745221 BACKGROUND

Related Links

• Activate adult. World rugby injury prevention exercise programme.

MeSH Terms

Conditions

Anterior Cruciate Ligament Injuries

Condition Hierarchy (Ancestors)

Knee Injuries; Leg Injuries; Wounds and Injuries

Study Officials

• Ariadna d Morales, MD

  National Institute of Rehabilitation

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Andrea P Perez, MSc

CONTACT

525559991000; apegueros@inr.gob.mx

Rebeca S Romero, MSc

CONTACT

525559991000; rsalas@inr.gob.mx

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: March 30, 2023
• First Posted: April 14, 2023
• Study Start: August 20, 2021
• Primary Completion: December 20, 2023
• Study Completion: March 20, 2024
• Last Updated: April 14, 2023

Record last verified: 2023-03

Data Sharing

• IPD Sharing: Will not share

Locations

ME (1)