Perturbation Training vs Functional Activities on Pain, ROM, Balance, and Function Post-ACL

NCT07642752 | Not Yet Recruiting

• 1 other identifier: REC/RCR&AHS/25/0118
• Study Type: interventional
• Target: 54
• Locations: 1 country
• Sites: 1

Brief Summary

Anterior cruciate ligament (ACL) injuries are among the most common and functionally disabling knee injuries, particularly in physically active individuals. Despite advancements in surgical techniques, optimal post-operative rehabilitation remains critical for successful functional recovery, minimizing re-injury risk, and restoring pre-injury performance levels

Conditions

Anterior Cruciate Ligament Injuries

Keywords

Knee; Disability; Range of motion; Balance

Outcome Measures

Primary Outcomes (4)

• NPRS for Pain

  Numeric Pain Rating Scale (NPRS) it is a unidimensional scale to measure pain intensity, particularly in adults. It is a 10-rating scale and an 11-point numeric scale in the form of a horizontal bar or line

  6 weeks

• Universal Goniometer for Range of motion

  A universal goniometer (UG) will be used to determine the range of motion of the target joint.

  6 weeks

• The Y-Balance test (YBT)

  The Y-Balance test (YBT) is used to assess dynamic balance impairments associated with lower extremity injuries such as ACL injury, patellofemoral pain syndrome, and ankle instability.

  6 weeks

• International Knee Documentation Committee scores (IKDC)

  Patients' knee function is evaluated using the International Knee Documentation Committee's (IKDC) Subjective Knee Form. Through 18 questions, it assesses symptoms, athletic activity, and general knee function; higher scores indicate better knee function.

  6 weeks

Study Arms (3)

Perturbation Training Group

EXPERIMENTAL

Participants undergo perturbation-based exercises designed to improve knee stability. It includes balance boards, BOSU balls, and manual perturbation techniques.

Other: Perturbation Training Group; Other: Control Group (Standard Rehabilitation Protocol)

Task-Oriented Functional Activities Group

ACTIVE COMPARATOR

Participants engage in functional movement exercises that mimic daily activities. It includes step training, agility drills, and controlled landing mechanics.

Other: Task-Oriented Functional Activities Group; Other: Control Group (Standard Rehabilitation Protocol)

Control Group (Standard Rehabilitation Protocol)

SHAM COMPARATOR

Participants follow traditional ACL rehabilitation without perturbation or task-oriented interventions. It includes strength training, range-of-motion exercises, and proprioceptive drills.

Other: Control Group (Standard Rehabilitation Protocol)

Interventions

Perturbation Training Group OTHER

Two-leg rocker board One-leg rocker board Roller board / stable (weight scale) surface Roller board / BOSU ball TheraBand feedback / perturbation training Simple sport-specific technique on rocker board Moderate demand sport-specific technique on rocker board Advanced sport-specific technique on rocker board This sequence reflects a progressive challenge to knee stability, beginning with bilateral balance tasks, advancing to unilateral control, and culminating in sport-specific perturbation drills.

Perturbation Training Group

Control Group (Standard Rehabilitation Protocol) OTHER

Heating pad (5-10 minutes) TENS (short bursts, 10-15 minutes, frequency 100 Hz) Stationary cycling Gentle range of motion exercises Passive and active-assisted ROM Isometric quadriceps contractions Straight leg raises Quadriceps setting with a towel under the knee Closed-chain exercises (e.g., wall sits, mini-squats) Hamstring curls Double-leg stance on foam pad This set emphasizes pain relief, mobility restoration, and foundational strength before progressing to advanced neuromuscular or sport-specific tasks.

Control Group (Standard Rehabilitation Protocol); Perturbation Training Group; Task-Oriented Functional Activities Group

Task-Oriented Functional Activities Group OTHER

Functional Recovery Tasks After ACLR Normal walking gait Bilateral squat Unilateral foundation exercises - Single leg squat Bilateral landing Running - Run on treadmill Bilateral plyometric - Bilateral drop jump Unilateral landing / deceleration - Single leg deceleration Unilateral plyometric - Single leg drop jump Change of direction ability / coordination - 90º cut maneuver Sport-specific movements - Movement control under sport-specific change of direction This sequence reflects a progressive load and skill development pathway, starting from basic gait and bilateral tasks, moving toward unilateral control, plyometrics, and finally sport-specific agility.

Task-Oriented Functional Activities Group

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age range: 18-45 years
• Male participants only
• History of Anterior Cruciate Ligament Reconstruction (ACLR) of 3 to 12 months
• No prior ACL surgery on the affected knee
• ACL reconstruction with autograft of hamstrings tendon
• Knee flexion range of motion less than 120°
• Extension lag less than or equal to 10°
• Pain during functional activities

You may not qualify if:

• Any type of fracture
• Concurrent ligamentous injury or repairable meniscus
• Osteochondral defect
• Any systemic and/or neurological illness
• Rheumatoid arthritis
• Osteomyelitis or any neurological disorders
• Spinal disorders
• Inflammatory conditions such as ankylosing spondylitis

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Ghurki Hospital Lahore

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (4)

• Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord. 2020 Oct 3;21(1):647. doi: 10.1186/s12891-020-03676-6.

  PMID: 33010802 BACKGROUND

• Hetsroni I, Mann G, Arami E, van Stee M, Marom N, Ohana N. Young men undergoing anterior cruciate ligament reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to those undergoing reconstruction with hamstring autograft and transtibial drilling. J ISAKOS. 2024 Aug;9(4):540-548. doi: 10.1016/j.jisako.2024.04.001. Epub 2024 Apr 3.

  PMID: 38580054 BACKGROUND

• Nawasreh Z, Logerstedt D, Marmon A, Snyder-Mackler L. Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture. J Sport Rehabil. 2019 Nov 1;28(8):877-886. doi: 10.1123/jsr.2017-0363.

  PMID: 30300071 BACKGROUND

• Brown SR, Washabaugh EP, Dutt-Mazumder A, Wojtys EM, Palmieri-Smith RM, Krishnan C. Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study. Sports Health. 2021 Mar;13(2):136-144. doi: 10.1177/1941738120955184. Epub 2020 Dec 18.

  PMID: 33337984 BACKGROUND

MeSH Terms

Conditions

Anterior Cruciate Ligament Injuries

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Knee Injuries; Leg Injuries; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Hira Shaukat, Mphill

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, PhD

CONTACT

03324390125; Imran.amjad@riphah.edu.pk

Hira Butt

CONTACT

03360405480; hirabutt7582@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 8, 2026
• First Posted: June 11, 2026
• Study Start (Estimated): June 20, 2026
• Primary Completion (Estimated): October 15, 2026
• Study Completion (Estimated): November 6, 2026
• Last Updated: June 11, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)