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Jatin P. Ambegaonkar, Sandra J. Shultz, David H. Perrin and Mark R. Schulz

Edited by Mary Barnum

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Brian Powell, Wendy Hurd and Lynn Snyder-Mackler

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Kevin E. Wilk, Naiquan Zheng, Glenn S. Fleisig, James R. Andrews and William G. Clancy

Closed kinetic chain exercise has become popular in rehabilitation of the ACL patient. While many clinicians agree on the benefits of closed kinetic chain exercise, there is great discrepancy as to which exercises fit this category. This discrepancy stems from the fact that the kinetic chain concept was originally developed using mechanical engineering concepts and not human kinesiology. In this paper, the kinetic chain concept is redefined in a continuum of lower extremity exercises from closed kinetic chain to open kinetic chain. The placement of an exercise in this continuum is based upon joint kinematics, quadriceps and hamstring muscle activity, cruciate ligament stress, and joint weight-bearing load. An understanding of these factors can help the clinician design a comprehensive and effective rehabilitation program for the ACL patient.

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Gregory D. Myer, Kevin R. Ford and Timothy E. Hewett

Edited by Tricia J. Hubbard

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Dustin R. Grooms, Adam W. Kiefer, Michael A. Riley, Jonathan D. Ellis, Staci Thomas, Katie Kitchen, Christopher A. DiCesare, Scott Bonnette, Brooke Gadd, Kim D. Barber Foss, Weihong Yuan, Paula Silva, Ryan Galloway, Jed A. Diekfuss, James Leach, Kate Berz and Gregory D. Myer

Successful strategies aimed at the reduction of anterior cruciate ligament (ACL) injury risk hinge on adaptations to the neuromuscular control system that modulates movement patterns and ultimately transfers desirable biomechanics to sport. 1 Full optimization of neuromuscular training aimed at

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Giampietro L. Vairo, Nicole M. McBrier, Sayers John Miller and William E. Buckley

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Michael A. Samaan, Eric K. Greska, Matthew C. Hoch, Joshua T. Weinhandl, Sebastian Y. Bawab and Stacie I. Ringleb

Context:

ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.

Objective:

To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).

Participant:

One Division I female athlete.

Main Outcome Measure:

The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.

Results:

ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.

Conclusion:

Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

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P.R. Rougier, S. Berger, S. Barral and O. Rachet

To assess the postural strategies developed over the first 2 months following surgery by ACL patients during rehabilitation and highlight the sensory-motor impairment recovery, 21 patients were measured at three timeframes. Three two-legged standing conditions were assessed: with the eyes open, with the eyes closed either wearing or not wearing a knee orthosis. The results indicate that the weight-bearing asymmetry, initially observed (i.e., 56–44% of body-weight), disappeared progressively during rehabilitation (51–49%). The comparison of the plantar center-of-pressure displacements under both sound and operated legs demonstrated noticeable differences that also tended to decrease but without reaching a matched behavior during the last measures. These effects were seen in both eyes open and eyes closed conditions with the greatest effects in the latter condition. Wearing a knee orthosis inferred no particular changes in the postural control behaviors. These data could be used as benchmarks for highlighting the effects on undisturbed postural control of various surgery techniques and/or rehabilitation protocols.