Lower limb stability with ACL impairment.

STUDY DESIGN

Repeated measures (3 separate day sessions) to determine test reliability; single-session repeated measures to compare stability between limbs.

OBJECTIVES

To develop a functional test measuring dynamic stability that is capable of differentiating between the injured and uninjured lower limb in 2 populations: (1) people with anterior cruciate ligament deficiency (ACLd) and (2) people with anterior cruciate ligament reconstruction (ACLr), and to establish the reliability of this test.

BACKGROUND

Many functional tests of the lower limb used by clinicians, such as the 1-legged hop for distance, the 1-legged hop for time, the vertical jump, the triple hop for distance, shuttle run, and single-limb standing, do not allow the clinician to discern differences between function in the injured and uninjured limbs.

METHODS AND MEASURES

Twenty-five nonimpaired subjects (14 men, 11 women, aged 31.2 +/- 9.1 years), 11 subjects with ACLr (9 men, 2 women, aged 26.3 +/- 10.4 years), and 13 subjects with ACLd (5 men, 8 women, aged 40.4 +/- 12.6 years) were tested. Twelve nonimpaired subjects participated in 3 testing sessions to determine the reliability of the force plate measures. Ground reaction forces (vertical, medial-lateral, and anterior-posterior) were measured while the subjects performed 1-legged hop and step-down tests onto a force plate. Stability was defined as the ability to transfer the vertical projection of the center of gravity to the supporting base and keep the knee still. A repeated-measures analysis of variance (2-factor; limbs by trials) was used to compare the stability between limbs.

RESULTS

The majority of the measures used to calculate dynamic stability were reliable. Moreover, the data provide normal standards of functional knee stability for step-down and hop tests. In the step-down test, changes in vertical force did identify dysfunction in the injured limb (stabilization time = 1527 +/- 216 ms) compared to the uninjured limb (stabilization time = 892 +/- 498 ms) for subjects with ACLr.

CONCLUSIONS

The normal standards may serve as a reference for comparing functional differences in ACLr or ACLd populations. The vertical force parameter during a step-down may be useful as an outcome measure to monitor progress during rehabilitation.