Reduction Of Risk Factors For Acl Re-injuries Using An Innovative Biofeedback Approach: A Randomized Clinical Trial
Year: 2021
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Reduced kinetic symmetry during bilateral landing is associated with an increased risk for second anterior cruciate ligament (ACL) injuries in patients returning to sport following ACL reconstruction (ACLR). Real-time biofeedback can improve kinetic symmetry during squatting; however, it is unknown if improved squatting symmetry will transfer to landing movements. PURPOSE: Explore the efficacy of a novel biofeedback intervention to improve landing mechanics following ACLR. METHODS: Forty patients recovering from a primary unilateral ACLR (age: 16 ± 2 years, 24 male/16 female; 20 hamstring/20 patellar tendon graft) were randomized into either an intervention (n = 18) or attention control (n = 22) group. The intervention consisted of 12 biofeedback sessions (2 per week for 6 weeks). At each session, patients completed bilateral squatting with visual weight-distribution biofeedback and position correcting tactile biofeedback. Lower extremity kinematics and kinetics were collected during bilateral stop jumps at baseline, post-intervention (6-weeks after baseline), and retention (12-weeks after baseline) time points. The primary outcome measure was knee extension moment symmetry (KEM-SYM) with secondary outcomes being peak vertical ground reaction force symmetry (vGRF-SYM), peak knee flexion angle, and peak knee abduction angle post-intervention. A linear mixed-effects regression analysis was used to determine the main effects of and interactions between group, time, and sex, controlling for graft type. RESULTS: KEM-SYM improved equally across time for both groups (baseline: 46.0 ± 21.2, 6-weeks: 41.6 ± 17.3, 12-weeks: 34.9 ± 17.3; p = 0.002). There was a group by time interaction for vGRF-SYM (p = 0.011), with the intervention group having greater symmetry improvements between baseline and post-intervention. However, these improvements were not maintained at the retention visit. Peak knee flexion improved post-intervention (p < 0.001), however, there were no group differences for changes in peak knee flexion or peak knee abduction across time. CONCLUSION: Both groups had similar improvements in KEM-SYM, while the intervention group had greater improvements in vGRF-SYM. Future work should develop and test psychological and biofeedback interventions to decrease second ACL injury risk.
Authors: Robin Queen, Alexander T. Peebles, Thomas K. Miller, Jyoti Savla, Thomas Ollendick, Stephen P. Messier, DS Blaise Williams
Institutions: Virginia Tech, Wake Forest University, Nike (United States)
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3179457768