Negative Effects on Postural Control After Anterior Cruciate Ligament Reconstruction as Measured by the Balance Error Scoring System

in Journal of Sport Rehabilitation

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Mason D. Smith
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David R. Bell
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Anterior cruciate ligament (ACL) reconstruction is the standard of care for individuals with ACL rupture. Balance deficits have been observed in patients with ACL reconstruction (ACLR) using advanced posturography, which is the current gold standard. It is unclear if postural-control deficits exist when assessed by the Balance Error Scoring System (BESS), which is a clinical assessment of balance.


The purpose of this study is to determine if postural-control deficits are present in individuals with ACLR as measured by the BESS.


Thirty participants were included in this study. Fifteen had a history of unilateral ACLR and were compared with 15 matched controls.


The BESS consists of 3 stances (double-limb, single-limb, and tandem) on 2 surfaces (firm and foam). Participants begin in each stance with hands on their hips and eyes closed while trying to stand as still as possible for 20 s.

Main Outcome Measures:

Each participant performed 3 trials of each stance (18 total), and errors were assessed during each trial and summed to create a total score.


We observed a significant group × stance interaction (P = .004) and a significant main effect for stance (P < .001). Post hoc analysis revealed that the ACLR group had worse balance on the single-leg foam stance than did controls. Finally, the reconstructed group had more errors when total BESS score was examined (P = .02).


Balance deficits exist in individuals with ACLR as measured by the BESS. Total BESS score was different between groups. The only condition that differed between groups was the single-leg stance on the unstable foam surface.

The authors are with the Dept of Kinesiology, University of Wisconsin–Madison, Madison, WI.

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