Proprioceptive Training for Gait and Knee Function After Anterior Cruciate Ligament Reconstruction

NCT07268651 | Not Yet Recruiting

• 1 other identifier: USM/JEPeM/KK/25030296
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior cruciate ligament reconstruction (ACLR) is commonly performed to restore knee stability after injury, but many patients continue to experience gait abnormalities and reduced knee function during rehabilitation. Proprioceptive training is frequently included in rehabilitation programs to improve joint position sense, neuromuscular control, and movement coordination, yet its specific effects on gait performance and knee function after ACLR are not fully understood. This study aims to investigate the effects of a 12-week proprioceptive training program on gait performance and knee function in patients who have undergone ACLR. Patients who meet the inclusion criteria will undergo baseline assessments, including gait analysis and knee function tests. They will then participate in a structured 12-week proprioceptive training program as part of their rehabilitation, followed by post-intervention assessments using the same measures. The primary outcomes include changes in gait performance, such as walking speed, step length, cadence, support time, knee motion, and knee joint angles and moments during walking. Secondary outcomes include changes in knee function, including isokinetic muscle strength, joint position sense, and patient-reported outcomes measured by the Lysholm score and the International Knee Documentation Committee (IKDC) questionnaire. The findings from this study may help to clarify the functional benefits of proprioceptive training and support the development of more targeted and effective rehabilitation strategies for patients recovering from Anterior cruciate ligament (ACL) injuries.

Conditions

Anterior Cruciate Ligament Reconstruction

Keywords

Proprioceptive Training; Gait Performance; Knee Function; Joint Position Sense

Outcome Measures

Primary Outcomes (10)

• Walking Speed

  Walking speed during level walking measured using 3D gait analysis. Unit of measure: meters per second (m/s).

  Baseline and 12 weeks post-intervention

• Step Length

  Step length measured during level walking using 3D gait analysis. Unit of measure: meters (m).

  Baseline and 12 weeks post-intervention.

• Cadence

  Cadence during level walking measured using 3D gait analysis. Unit of measure: steps per minute (steps/min).

  Baseline and 12 weeks post-intervention.

• Single Support Time

  Single support time of the gait cycle measured using 3D gait analysis. Unit of measure: seconds (s).

  Baseline and 12 weeks post-intervention.

• Double Support Time

  Double support time of the gait cycle measured using 3D gait analysis. Unit of measure: seconds (s).

  Baseline and 12 weeks post-intervention.

• Peak Knee Flexion Angle

  Peak knee flexion angle during the stance phase measured using 3D gait analysis. Unit of measure: degrees (°).

  Baseline and 12 weeks post-intervention.

• Peak Knee Extension Angle

  Peak knee extension angle during the stance phase measured using 3D gait analysis. Unit of measure: degrees (°).

  Baseline and 12 weeks post-intervention.

• Peak Knee Flexion Moment

  Peak external knee flexion moment measured during walking using 3D gait analysis. Unit of measure: Newton-meters per kilogram (Nm/kg).

  Baseline and 12 weeks post-intervention.

• Peak Knee Extension Moment

  Peak external knee extension moment measured during walking using 3D gait analysis. Unit of measure: Newton-meters per kilogram (Nm/kg).

  Baseline and 12 weeks post-intervention.

• Knee Range of Motion

  Total sagittal plane knee range of motion measured during level walking using 3D gait analysis. Unit of measure: degrees (°).

  Baseline and 12 weeks post-intervention.

Secondary Outcomes (4)

• Changes in isokinetic knee muscle strength

  Baseline and 12 weeks post-intervention

• Changes in knee joint position sense accuracy

  Baseline and 12 weeks post-intervention

• Change in Lysholm Knee Scoring Scale

  Baseline and 12 weeks post-intervention

• Change in International Knee Documentation Committee Subjective Knee Form Score

  Baseline and 12 weeks post-intervention

Study Arms (2)

Control Group

ACTIVE COMPARATOR

Participants in this arm will receive a standard rehabilitation program adapted from the Massachusetts General Brigham Sports Medicine Anterior cruciate ligament Reconstruction Rehabilitation Protocol. The rehabilitation sessions will be conducted twice per week. The 12-week program is delivered in four progressive phases focusing on graft protection, restoration of knee range of motion, quadriceps activation, balance, and strengthening exercises. No additional proprioceptive training will be provided in this arm.

Behavioral: Standard Rehabilitation

Proprioceptive Training Group

EXPERIMENTAL

Participants in this arm will receive a structured 12-week proprioceptive training program in addition to the standard rehabilitation protocol. The proprioceptive training is adapted from validated progressive exercise programs using Swiss balls and BOSU balls, and includes balance, coordination, and neuromuscular control exercises. Training sessions are supervised by a physiotherapist and performed three times per week. The progression follows three stages (initial: weeks 1-5, intermediate: weeks 5-8, advanced: weeks 8-12), with advancement allowed only when exercises can be performed with adequate balance control and without pain.

Behavioral: Standard Rehabilitation; Behavioral: Proprioceptive Training

Interventions

Standard Rehabilitation BEHAVIORAL

A standard rehabilitation program adapted from the Massachusetts General Brigham Sports Medicine Anterior cruciate ligament Reconstruction Rehabilitation Protocol. The program consists of supervised rehabilitation sessions conducted twice per week for 12 weeks. The protocol includes four progressive phases focusing on graft protection, restoration of knee range of motion, quadriceps activation, balance training, and progressive strengthening exercises. No proprioceptive training components are included in this intervention.

Control Group; Proprioceptive Training Group

Proprioceptive Training BEHAVIORAL

A structured 12-week proprioceptive training program performed in addition to standard rehabilitation. The program is adapted from validated progressive proprioceptive exercise protocols using Swiss balls and BOSU balls. Training sessions are supervised by a physiotherapist and conducted three times per week. Exercises progress through three stages (initial: weeks 1-5, intermediate: weeks 5-8, and advanced: weeks 8-12) and include balance, coordination, and neuromuscular control activities. Participants advance to the next level only when exercises can be performed with adequate balance control and without pain.

Proprioceptive Training Group

Eligibility Criteria

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

You may qualify if:

• Adults aged 18-40 years who have undergone primary unilateral anterior cruciate ligament reconstruction (ACLR) using an autograft.
• At least 3 weeks postoperatively and currently engaged in the early-stage rehabilitation phase following ACLR.
• Demonstrate near-full passive knee extension (≤ 5° loss) and at least 90° of passive knee flexion in the operated limb.
• Able to walk independently without assistive devices and perform basic functional tasks (e.g., normal walking, single-leg stance).
• No prior surgery or major injury to the contralateral knee or other lower limb joints.
• No neurological, vestibular, or systemic conditions affecting proprioception, motor control, or physical performance.
• Not currently participating in any structured proprioceptive or neuromuscular training programs.
• Willing and able to comply with the intervention protocol and follow-up, and able to provide written informed consent.

You may not qualify if:

• History of revision anterior cruciate ligament surgery, bilateral ACLR, or concurrent reconstruction of other knee ligaments (e.g., posterior cruciate ligament, medial collateral ligament, lateral collateral ligament) in the affected knee.
• Meniscal repair or other intra-articular procedures that restrict knee range of motion beyond 3 weeks postoperatively.
• Diagnosed osteoarthritis, rheumatoid arthritis, or other chronic joint diseases affecting the lower limbs.
• Significant injury, surgery, or persistent pain in the contralateral knee, hip, ankle, or spine that could interfere with training or gait.
• History or current diagnosis of neurological disorders (e.g., stroke, multiple sclerosis, Parkinson's disease) or vestibular dysfunction.
• Any cardiopulmonary or systemic condition that contraindicates structured physical exercise.
• Participation in other structured rehabilitation or proprioceptive training programs within the past 3 weeks.
• Cognitive impairment or psychiatric conditions that may interfere with understanding instructions or complying with the protocol.

Sponsors & Collaborators

• Universiti Sains Malaysia: lead

Study Sites (1)

Leshan Vocational College

Leshan, Sichuan, 614000, China

Location

Study Officials

• Shazlin Shaharudin, PhD

  Universiti Sains Malaysia

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Shiwei Chen

CONTACT

+8618045040049; chenccchi@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: December 8, 2025
• Study Start: December 1, 2025
• Primary Completion: March 1, 2026
• Study Completion: April 1, 2026
• Last Updated: December 8, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)