The primary goal of this RCT is to evaluate the effects of isokinetic training compared to plyometric training after 4weeks of intervention in patients aged 18-40 years who have undergone ACLR surgery.
The primary question to answer is which of the two interventions (isokinetic or plyometrics) has superior effect in the improvement of muscular strength, functional performance and patient-reported outcomes in ACLR patients.
Participants will be divided into two groups. both groups received standard rehabilitation for 4 weeks, followed by adding: Group 1: receives isokinetic training, Group 2: receives plyometric training.
Age 18-40 years
Primary unilateral ACL reconstruction
Reconstruction using bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft
Cleared by operating surgeon for progressive resistance and functional training
Revision ACL reconstruction
Associated grade III ligament injury
Meniscal repair (meniscectomy is not an exclusion)
Concomitant chondral defect requiring surgical intervention or cartilage repair
Parallel
Isokinetic Training
Other interventionIsokinetic training will be added to the standard rehabilitation program 4 weeks post-surgery and will be continued for 4 weeks.
Plyometrics Training
Other interventionPlyometrics training will be added to the standard rehabilitation program 4 weeks post-surgery and will be continued for 4 weeks.
Isokinetic Quadriceps & Hamstring Peak Torques Normalized to Body Weight
The peak torques of quadriceps and hamstring are considered as the highest peak torque along the 5 repetitions at velocity 60°/s. Each is then normalized to body mass by the following equation: PTrelative = Peak Torque (Nm) / Body Mass (kg).
Isokinetic Limb Symmetry Index (ISOK-LSI) of Quadriceps & Hamstring
ISOK-LSI is calculated by the following equation: ISOK-LSI = (involved limb PT / uninvolved limb PT) × 100. An LSI \>90% is commonly used as a criterion for adequate interlimb symmetry following ACL reconstruction.
Hamstring - Quadriceps Ratio (H/Q)
H/Q is calculated by the following equation: H/Q = (hamstring PT/quadriceps PT) × 100. The hamstring-to-quadriceps (H/Q) ratio was calculated as the ratio of hamstring peak torque to quadriceps peak torque, expressed as a percentage. H/Q ratio of approximately 66.7% at 60°/s has been suggested as a reference value.
Functional Performance test
For the distance tests (single-leg, triple ho, crossover hop), the longest distance (cm) is the best and is measured in centimeters using calibrated floor markings. For the time related test (6-meter timed hop), the shortest time (s) is considered and is measured using a digital stopwatch. For all four hop tests, 3 trials will be performed. The best trial will be taken to statistical analysis.
Visual Analog Scale (VAS)
VAS is a subjective tool designed to assess the intensity of pain by providing quantitative measures of self-reported severity of symptoms. Ranges are: 0-3 indicates mild pain, 4-6 moderate pain, and 7-10 severe pain.
Knee Injury and Osteoarthritis Outcome Score (KOOS)
KOOS is a subjective tool designed to measure the patients' opinion about their knee function and problems related to injuries that may lead to osteoarthritis including ACL, meniscal or chondral injuries. It is composed of 5 domains: 1) Symptoms, 2) Stiffness, 3) Pain, 4) Function - daily living, and 5) Function - sports and recreational activities, of total 42 items. The sum of all 5 dimensions represents the total score that is then transformed to a 0-100 score (%), where 0 indicates "extreme knee problem" and 100 indicates "no knee problems".
Click on the lead sponsor to view all of their trials.
