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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Research

Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study

Authors: Marilia Novaes, Adriana Carvalho, Juliana F. Sauer, Guilherme C. Brech, Camilo P. Helito, Silvia M. A. João

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group.

Methods

An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group.

Results

The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 ± 6.77 vs. 13.98 ± 6.64, p < 0.001); Mean ML displacement (2.58 ± 2.02 vs. 3.72 ± 1.99, p < 0.001); Total AP displacement (9.5 ± 3.97 vs. 11.7 ± 3.66, p = 0.001); Mean AP displacement (1.77 ± 0.87 vs. 2.27 ± 0.86, p = 0.001); Area of displacement (111.44 ± 127.3 vs. 183.69 ± 131.48, p < 0.001).

Conclusion

Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.

Palm HG, Brattinger F, Stegmueller B, Achatz G, Riesner HJ, Friemert B. Effects of knee bracing on postural control after anterior cruciate ligament rupture. Knee. 2012;19(5):664–71. https://doi.org/10.1016/j.knee.2011.07.011.CrossRefPubMed

Zouita Ben Moussa A, Zouita S, Dziri C, Ben Salah FZ. Single-leg assessment of postural stability and knee functional outcome two years after anterior cruciate ligament reconstruction. Ann Phys Rehabil Med. 2009;52(6):475–84. https://doi.org/10.1016/j.rehab.2009.02.006.CrossRefPubMed

Lehmann T, Paschen L, Baumeister J. Single-leg assessment of postural stability after anterior cruciate ligament injury: a systematic review and meta-analysis. Sports Med Open. 2017;3(1):32. https://doi.org/10.1186/s40798-017-0100-5.CrossRefPubMedPubMedCentral

Pollock AS, Durward BR, Rowe PJ, Paul JP. What is balance? Clin Rehabil. 2000;14(4):402–6. https://doi.org/10.1191/0269215500cr342oa.CrossRefPubMed

Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006;35 Suppl 2:ii7–ii11. https://doi.org/10.1093/ageing/afl077.CrossRefPubMed

Howells BE, Ardern CL, Webster KE. Is postural control restored following anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1168–77. https://doi.org/10.1007/s00167-011-1444-x.CrossRefPubMed

Negahban H, Mazaheri M, Kingma I, Van Dieen JH. A systematic review of postural control during single-leg stance in patients with untreated anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1491–504. https://doi.org/10.1007/s00167-013-2501-4.CrossRefPubMed

Duarte M, Freitas SM. Revision of posturography based on force plate for balance evaluation. Rev Bras Fis. 2010;14(3):183–92.CrossRef

Brech GC, Plapler PG, de Souza Meirelles E, Marcolino FM, Greve JM. Evaluation of the association between osteoporosis and postural balance in postmenopausal women. Gait Posture. 2013;38(2):321–5. https://doi.org/10.1016/j.gaitpost.2012.12.012.CrossRefPubMed

10.

Brech GC, Fonseca ÂM, Bagnoli VR, Baracat EC, Greve JM. Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis. Clinics (Sao Paulo). 2013;68(10):1293–8.CrossRef

11.

Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J. A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy. 2015;31(3):583–91. https://doi.org/10.1016/j.arthro.2014.09.010.CrossRefPubMed

12.

Monaco E, Sonnery-Cottet B, Daggett M, Saithna A, Helito CP, Ferretti A. Elimination of the pivot-shift sign after repair of an occult anterolateral ligament injury in an ACL-deficient knee. Orthop. J Sports Med. 2017;5(9). https://doi.org/10.1177/2325967117728877.

13.

Sonnery-Cottet B, Daggett M, Fayard JM, et al. Anterolateral ligament expert group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol. 2017;18(2):91–106. https://doi.org/10.1007/s10195-017-0449-8.CrossRefPubMedPubMedCentral

14.

Sobrado MF, Giglio PN, Bonadio MB, Helito P, et al. Outcomes after isolated acute anterior cruciate ligament reconstruction are inferior in patients with an associated anterolateral ligament injury. Am J Sports Med. 2020;48(13):3177–82. https://doi.org/10.1177/0363546520956266.CrossRefPubMed

15.

Bonanzinga T, Signorelli C, Grassi A, et al. Kinematics of ACL and anterolateral ligament. Part I: Combined lesion. Knee Surg Sports Traumatol Arthrosc. 2017;25(4):1055–61. https://doi.org/10.1007/s00167-016-4259-y.CrossRefPubMed

16.

Helito CP, Camargo DB, Sobrado MF, et al. Combined reconstruction of the anterolateralligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3652–9. https://doi.org/10.1007/s00167-018-4934-2.CrossRefPubMed

17.

Helito CP, Saithna A, Bonadio MB, et al. Anterolateral ligament reconstruction: a possible option in the therapeutic arsenal for persistent rotatory instability after ACL reconstruction. Orthop J Sports Med. 2018;6(1):2325967117751348. https://doi.org/10.1177/2325967117751348.CrossRefPubMedPubMedCentral

18.

Helito CP, Sobrado MF, Giglio PN, et al. Combined reconstruction of the anterolateral ligament in patients with anterior cruciate ligament injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated anterior cruciate ligament reconstruction. Arthroscopy. 2019;35(9):2648–54. https://doi.org/10.1016/j.arthro.2019.03.059.CrossRefPubMed

19.

Getgood A, Brown C, Lording T, et al. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):166–76. https://doi.org/10.1007/s00167-018-5072-6.CrossRefPubMed

20.

Lima AD, Helito CP, Lima FRA, Leite JAD. Indicações cirúrgicas para reconstrução do ligamento cruzado anterior combinada com tenodese extra- articular lateral ou reconstrução do ligamento anterolateral. RevBrasOrtop. 2018;53(6):661–7. https://doi.org/10.1016/j.rbo.2017.06.027.CrossRef

21.

Culvenor AG, Alexander BC, Clark RA, et al. Dynamic Single-Leg Postural Control Is Impaired Bilaterally Following Anterior Cruciate Ligament Reconstruction: Implications for Reinjury Risk. J Orthop Sports PhysTher. 2016;46(5):357–64. https://doi.org/10.2519/jospt.2016.6305.CrossRef

22.

Ariel de Lima D, Helito CP, Lacerda de Lima L, Dias Leite JA, Costa Cavalcante ML. Study of the nerve endings and mechanoreceptors of the anterolateral ligament of the knee. Arthroscopy. 2019;35(10):2918–27. https://doi.org/10.1016/j.arthro.2019.05.02324.CrossRefPubMed

23.

Salavati M, Hadian MR, Mazaheri M, et al. Test-retest reliability [corrected] of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability. Gait Posture. 2009;29(3):460–4. https://doi.org/10.1016/j.gaitpost.2008.11.016.CrossRefPubMed

24.

Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no brasil. Rev Bras Ativ Fís Saúde. 2012;6(2):5–18. https://doi.org/10.12820/rbafs.v.6n2p5-18.CrossRef

25.

Kilinc BE, Kara A, Celik H, Oc Y, Camur S. Evaluation of the accuracy of Lachman and Anterior Drawer Tests with KT1000 ın the follow-up of anterior cruciate ligament surgery. J Exerc Rehabil. 2016;12(4):363–7. https://doi.org/10.12965//jer.1632622.311.CrossRefPubMedPubMedCentral

26.

Lam MH, Fong DT, Yung P, Ho EP, Chan WY, Chan KM. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches. Sports Med Arthrosc Rehabil Ther Technol. 2009;1(1):20. https://doi.org/10.1186/1758-2555-1-20.CrossRefPubMedPubMedCentral

27.

Ernandes RC, Brech GC, Luna N, et al. Relationship of force platform with the clinical balance evaluation systems test in older adults. Acta Ortop Bras. 2020;28(3):111–3. https://doi.org/10.1590/1413-785220202803228895 PubMed ID: 32536789.CrossRefPubMedPubMedCentral

28.

Tookuni KS, Neto RB, Pereira AGP, Souza DR, Greve JMD, Ayal AD. Comparative analysis of postural control in individuals with and without lesions on the anterior cruciate ligament of the knee. Acta Ortop Bras. 2005;13(3):115–9. https://doi.org/10.1590/S1413-78522005000300003.CrossRef

29.

Okuda K, Abe N, Katayama Y, Senda M, Kuroda T, Inoue H. Effect of vision on postural sway in anterior cruciate ligament injured knees. J Orthop Sci. 2005;10(3):277–83. https://doi.org/10.1007/s00776-005-0893-9.CrossRefPubMed

30.

Tecco S, Salini V, Calvisi V, et al. Effects of anterior cruciate ligament (ACL) injury on postural control and muscleactivity of head, neck and trunkmuscles. J Oral Rehabil. 2006;33(8):576–87. https://doi.org/10.1111/j.1365-2842.2005.01592.x.CrossRefPubMed

31.

Kapreli E, Athanasopoulos S, Gliatis J, et al. Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study. Am J Sports Med. 2009;37(12):2419–26. https://doi.org/10.1177/0363546509343201.CrossRefPubMed

32.

Negahban H, Hadian MR, Salavati M, et al. The effects of dual-tasking on postural control in people with unilateral anterior cruciate ligament injury. Gait Posture. 2009;30(4):477–81. https://doi.org/10.1016/j.gaitpost.2009.07.112.CrossRefPubMed

33.

Wikstrom EA, Song K, Pietrosimone BG, Blackburn JT, Padua DA. Visual Utilization During Postural Control in Anterior Cruciate Ligament- Deficient and -Reconstructed Patients: Systematic Reviews and Meta-Analyses. Arch Phys Med Rehabil. 2017;98(10):2052–65. https://doi.org/10.1016/j.apmr.2017.04.010.CrossRefPubMed

34.

Lee JH, Heo JW, Lee DH. Comparative postural stability in patients with lateral meniscus versus medial meniscus tears. Knee. 2018;25(2):256–61. https://doi.org/10.1016/j.knee.2018.01.012.CrossRefPubMed

35.

Fernandes TL, Felix EC, Bessa F, et al. Evaluation of static and dynamic balance in athletes with anterior cruciate ligament injury - A controlled study. Clinics (Sao Paulo). 2016;71(8):425–9. https://doi.org/10.6061/clinics/2016(08)03.CrossRef

36.

O'Connell M, George K, Stock D. Postural sway and balance testing: a comparison of normal and anterior cruciate ligament deficient knees. Gait Posture. 1998;8(2):136–42. https://doi.org/10.1016/s0966-6362(98)00023-x.CrossRefPubMed

37.

Ageberg E, Roberts D, Holmström E, Fridén T. The effect of short-duration sub-maximal cycling on balance in single-limb stance in patients with anterior cruciate ligament injury: a cross-sectional study. BMC Musculoskelet Disord. 2004;5:44. https://doi.org/10.1186/1471-2474-5-44.CrossRefPubMedPubMedCentral

38.

Monaco E, Fabbri M, Mazza D, et al. The Effect of Sequentialtearing of the anterior cruciate and anterolateral ligament on anterior translation and the pivot-shift phenomenon: a cadaveric study using navigation. Arthroscopy. 2018;34(4):1009–14. https://doi.org/10.1016/j.arthro.2017.09.042.CrossRefPubMed

39.

Nielsen ET, Stentz-Olesen K, de Raedt S, et al. Influence of the anterolateral ligament on knee laxity: a biomechanical cadaveric study measuring knee kinematics in 6 degrees of freedom using dynamic radiostereometric analysis. Orthop J Sports Med. 2018;6(8):2325967118789699. https://doi.org/10.1177/2325967118789699.CrossRefPubMedPubMedCentral

40.

Thein R, Boorman-Padgett J, Stone K, Wickiewicz TL, Imhauser CW, Pearle AD. Biomechanical assessment of the anterolateral ligament of the knee: a secondary restraint in simulated tests of the pivot shift and of anterior stability. J Bone Joint Surg Am. 2016;98(11):937–43. https://doi.org/10.2106/JBJS.15.00344.CrossRefPubMed

41.

Sutton KM, Bullock JM. Anterior Cruciate Ligament Rupture: Differences Between Males and Females. JAAOS. 2013;21(1):41–50. https://doi.org/10.5435/JAAOS-21-01-41.CrossRefPubMed

42.

Daggett M, Helito CP, Cullen M, et al. The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences. Orthop J Sports Med. 2017;5(2):2325967116689387. https://doi.org/10.1177/2325967116689387.CrossRefPubMedPubMedCentral

Title: Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study
Authors: Marilia Novaes
Adriana Carvalho
Juliana F. Sauer
Guilherme C. Brech
Camilo P. Helito
Silvia M. A. João
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05347-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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