Influence of supervised and nonsupervised training on postural control after an acute anterior cruciate ligament rupture: A three-year longitudinal prospective study

Study Design: Prospective randomized longitudinal clinical trial with match ed controls. Objectives: To investigate the long-term effect of training on postural con trol and extremity function after an acute anterior cruciate ligament (ACL) injury. Background: ACL injuries may cause severe problems with recurrent giving wa y of the knee and reduced functional capacity. The effect of an acute ACL i njury and the effect of various training programs on postural control, as w ell as the relation between postural control and extremity function after s uch an injury, have not been studied longitudinally. Methods: Sixty-three consecutive patients, 35 men and 28 women (median age 24 years, quartiles 19-33 years), with an acute nonoperated ACL injury, ran domized to neuromuscular supervised or self-monitored training, were examin ed with stabilometry amplitude and average speed of center of pressure move ments and a one-leg hop test for distance after 6 weeks (stabilometry only) , and after 3, 12, and 36 months, and were compared to a control group. Results: Regardless of treatment, center of pressure amplitude was persiste ntly higher in both the injured and uninjured legs during the 3-year follow -up, hut average speed was less affected or unaffected compared to the cont rol group. The one-leg hop had normalized in the neuromuscular group at the 12-month follow-up, but was shorter in both legs throughout the 3-year per iod in the self-monitored group. The median value (quartiles) for injured/u ninjured legs at 3 months was 150 cm (120-174 cm)/177 cm (140-199 cm), at 1 2 months was 174 cm (140-200 cm)/180 cm (150-202 cm), and at 36 months was 172 cm (146-200 cm)/178 cm (150-200 cm) in the self-monitored group, compar ed to the control group (median 186 cm, quartiles 177-216 cm). Conclusions: The higher center of pressure amplitude in both legs over the 3-year period indicate persistently impaired postural control in single-lim b stance. However, functional performance, as measured with the one-leg hop test, was restored by neuromuscular training, but not by self-monitored tr aining.