Comparison of Two Different Rehabilitation Approaches Applied After Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament is incumbent upon the stabilization of the knee joint in our body. Consequently, it is also of great importance for athletes since it is seen that injuries in clinics are predominantly monitored in young individuals, who do active sports. Anterior cruciate ligament injuries commonly occur in football players when a secondary task (motor or cognitive) is involved while they are busy with a motor activity. In these processes, a circumstance, in which there becomes a quick landing after a jump or a difficult pass whilst dribbling the ball, can be monitored. In such cases, the subject of preventing these injuries, which may occur in athletes, and making them ready for second tasks after the treatment of the injury, has become a current issue. It is important for individuals who have suffered the injury- to be able to bring the knee joint to its former function at the highest level after anterior cruciate ligament reconstruction. As a result, the development of novel rehabilitation strategies has been an ongoing focus of research. A prime exemplar of this phenomenon is the implementation of dual-task exercises. Dual-task exercises appear in athletes as motor-cognitive or motor-motor. Athletes' exercising motor-cognitive functions has attracted the attention of researchers in the past period to prevent injuries in sports and has brought a new breath to the academic world. Studies suggest a decrease in cognitive and motor functions in the acute period after injuries. However, observing its long-term effects, they also suggest an increase in the attention parameter, crucial for athletes.

In a study examining postural stability in individuals, who underwent an operation of anterior cruciate ligament reconstruction by giving motor-motor or motor-cognitive exercises, it is seen that worse results are obtained in postural stability in individuals, who underwent only anterior cruciate ligament reconstruction compared to healthy individuals. Furthermore, in cases -in which eyes were closed and dual motor tasks were given-, more negative results are obtained compared to the open-eyed group. It is associated with a significant decrease in proprioceptive performance in individuals after anterior cruciate ligament injury. Owing to this decrease, postural control decreases, and negative situations arise due to the pathology of the individual. The star balance test is a sensitive test to determine and emerges as an exercise that will correct this negative situation. Post-ACL injury, individuals exhibit significantly lower physical component scores in quality-of-life assessments compared to healthy controls, as reported in books and articles. Moreover, after the ACL reconstruction, a decrease in the mental scores of the individual is seen owing to reasons such as long-term absenteeism from work, rehabilitation, the high costs of the operation, and traumatic occasions.

Foam roller, one of the current treatment modalities, is a myofascial release technique. The purpose of the foam roller application is to activate myofascial release by using the athlete's body weight and back-and-forth movement cycle. It has been observed that the usage of foam roller delays the emergence of delayed muscle soreness with myofascial release in the quadriceps and hamstring muscles, while also increasing joint range of motion. Despite the widespread utilization of foam rollers in clinical practice, empirical evidence elucidating the underlying mechanisms and clinical efficacy of this modality remains relatively limited. Nevertheless, the factors -which are consequential in the return to pre-injury performance of the athletes- have not been thoroughly scrutinized. For instance, there is no encounter in the literature examining the effects of dual-task exercises on kinesiophobia, ACL-specific quality of life, star balance test evaluation, normal range of motion evaluation, Tegner-Lysholm knee scoring scale.

The purpose of the study is to compare two different rehabilitation groups in terms of pain, range of motion, functionality, balance, quality of life, and kinesiophobia in individuals who underwent ACL reconstruction. The first group is the one with a dual-task approach given during walking and balance exercises together with the conventional physiotherapy program. The latter is the one with the same dual-task approach given during walking and balance exercises together, as an extra with a foam roller.


Eligibility Criteria:
Inclusion Criteria:

* Undergoing anterior cruciate ligament (ACL) reconstruction. Use of hamstring tendon autograft. Age between 18 and 40 years. At least 1 week but no more than 1 year post-surgery.

Exclusion Criteria:

* Presence of cardiovascular diseases. Any additional lower extremity disability (e.g., revision ACL reconstruction, other knee surgeries).

Diagnosis of back or lumbar pain. Any neurological disorders that could affect balance (e.g., epilepsy). Presence of posterior cruciate ligament (PCL) tear in addition to ACL injury.