Original Research

Neuromuscular Training Improves Biomechanical Deficits at the Knee in Anterior Cruciate Ligament–Reconstructed Athletes

Nagelli, Christopher V. MS, PhD^*; Wordeman, Samuel C. MS, PhD^†; Di Stasi, Stephanie PT, PhD^‡,†; Hoffman, Joshua MS, MBA^†; Marulli, Tiffany DPT^‡,†; Hewett, Timothy E. PhD^*,§,¶,║

Author Information

^*Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota;

^†Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio;

^‡Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State, Columbus, Ohio;

^§Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;

^¶Sports Medicine Center, Mayo Clinic, Rochester, Minnesota; and

^║Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota.

Corresponding Author: Timothy E. Hewett, PhD, Mayo Clinic, Orthopedic Surgery, Biomechanics, Sports Medicine Research, 200 First St SW, Rochester, MN 55095 ([email protected]).

The authors report no conflicts of interest.

Clinical Journal of Sport Medicine 31(2):p 113-119, March 2021. | DOI: 10.1097/JSM.0000000000000723

Abstract

Objective:

Athletes who return to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate persistent biomechanical and neuromuscular deficits of the knee. There is limited evidence on what effect a neuromuscular training (NMT) program has on knee biomechanics in a cohort of athletes with ACLR. Therefore, the primary aim of this study was to quantify the effect of an NMT program on knee biomechanics in a cohort of ACLR athletes. Second, the post-training knee biomechanics were compared between the cohort of ACLR and control athletes.

Design:

Cohort study.

Setting:

Controlled laboratory setting.

Participants:

Eighteen athletes with ACLR and 10 control athletes.

Interventions:

Neuromuscular training.

Main Outcome Measures:

Knee kinematics and kinetics during a double-limb jump-landing task.

Results:

There were no significant interactions (P > 0.05) observed for the athletes with ACLR. However, there was a significant main effect of biomechanics testing session (P < 0.05) for knee flexion angle and moments; athletes with ACLR demonstrated greater knee flexion angle and lower knee flexion moment during the post-training biomechanics testing session. Post-training comparison between the ACLR and control athletes demonstrated no significant interactions (P > 0.05) between the groups. There was a significant main effect of group (P < 0.05) for knee frontal angle, as athletes with ACLR landed with greater knee adduction than the control athletes.

Conclusions:

Significant improvements in knee sagittal plane biomechanical measures were observed after the NMT program by the athletes with ACLR. In addition, post-training comparison of the ACLR and control groups demonstrates comparable knee biomechanics.