The primary goal of this RCT is to evaluate the effect of adding plyometric training after 12 weeks of standard intervention in patients aged 18-40 years who have undergone ACLR surgery.
The primary question to answer is does adding plyometrics training to the standard rehabilitation program has superior effect in the improvement of muscular strength, dynamic balance and functional performance in ACLR patients. Participants will be divided into two groups. Group 1 receives standard program for 18 weeks, and Group 2 receives the same standard program for 18 months, but adding the plyometrics training at week 12.
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
Standard program
Other interventionStandard program is given for 18 weeks.
Plyometrics Training
Other interventionPlyometrics training will be added to the standard rehabilitation program 12 weeks post-surgery and will be continued for 6 weeks.
Isokinetic Quadriceps Peak Torques Normalized to Body Weight
The peak torque of quadriceps at 60°/s and 180°/s is considered as the highest peak torque along the 5 repetitions, each. It is then normalized to body mass by the following equation: PTrelative = Peak Torque (Nm) / Body Mass (kg).
Joint Position Sense (JPS)
JPS was assessed by the Biodex System 4Pro isokinetic dynamometer by the Active Angle Reproduction technique (AAR) with eyes closed. The measurements are taken along 30° and 60° for both involved and uninvolved legs respectively, starting with the uninvolved. For the assessment, the knee is moved from the starting position 90° flexed, into the targeted angles (30° \& 60°) with 10sec hold to memorize, then returned back to the starting position. After 10sec of rest pause, the participant is asked to actively move the leg to the angles with 6 trials for each angel. The mean reproduced angle value is calculated of the 6 trials at each angle to then calculate the JPS error by the following equation: JPSerror = Mean reproduced angle - targeted angle. The smaller the error, the better the participant's perception of joint position is
Dynamic Stability
Y-Balance Test is used to assess stability and balance in different directions. It is performed by leg reaches along 3 dimensions: anterior, posteromedial and posterolateral. The participant stands on one leg and reaches as far as possible with the second one along all three dimensions.
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.
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