Proprioceptive Isokinetic Repositioning, Functional Testing, and a Self-reported Questionnaire Before and After Anterior Cruciate Ligament Reconstruction

Study Overview
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Brief Summary
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This prospectively study aims to evaluate the evolution of knee joint proprioception on isokinetic dynamometer before and after Anterior Cruciate Ligament (ACL) reconstruction and its relationships with muscle strength, self reported questionnaire and return to sport. This study will include 30 athletes with isolated ACL rupture, and treated with ACL reconstruction surgery and 15 healthy volunteers.

Detailed Description
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Anterior cruciate ligament (ACL) rupture is a common injury in athletes. It has multiple consequences on the knee: instability, pain, loss of muscle strength, proprioceptive impairments, modification of the knee kinematics and premature knee osteoarthritis. In athletes, the majority of these injuries are treated with ACL reconstruction surgery. The main objective of this treatment is the reduction of knee instability to allow return to sport, and this at the same level prior to the injury. Thus, the athlete's follow-up after the surgery is essential to guide the return to sport and to ensure that the knee sensorimotor control allows the return to sport. Currently this assessment is based primarily on functional testings and measurement of muscle strength. The investigators propose to prospectively study the evolution of instrumentally measured knee proprioception using isokinetic dynamometer before and after ACL reconstruction as well as a study of the factors associated with its favorable evolution and its impact in the return to sport and its level.

Official Title
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Measurement and Relationships of Proprioceptive Isokinetic Repositioning With Muscle Strength, Functional Testing, and Self-reported Questionaires Before and After Anterior Cruciate Ligament Reconstruction: A Prospective Study With 12-months Post Operative Follow-up.

Conditions
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ACL Tear, ACL - Anterior Cruciate Ligament Deficiency

Intervention / Treatment
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* Device: Proprioception measurement on isokinetic dynamometer


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Isolated and primary tear of the ACL Individual candidate for an ACL reconstruction surgery. Acute ACL injury (<6 weeks) Athletes (person who competes in one or more sports that involve physical strength, speed or endurance) whatever their level of sport practice Internet access Exclusion Criteria: Prior knee surgery Complex ligamentous lesion (lateral ligaments, posterior cruciate ligament) Surgery for meniscal lesions (patients initially included but warranting meniscal surgery during arthroscopy will be secondarily excluded from the study.) Recent muscle damage History of significant injury on the healthy knee ACL rupture recurrence Pregnant woman Neurological or vestibular antecedent with sequelae Individuals taking treatment altering alertness (neuroleptics, sedatives) Informed consent not obtained

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention Group ACL: 30 patient, athletes, with ACL deficiency candidate to a surgical ACL reconstruction Control Group: 15 healthy volunteers, athletes.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: ACL<br>Intervention Group ACL: 30 patient, athletes, with ACL deficiency candidate to a surgical ACL reconstruction | Device: Proprioception measurement on isokinetic dynamometer<br>* Proprioception measurement on isokinetic dynamometer using joint position sense (JPS) and the threshold to detection of passive motion (TTDPM)<br>|
| Placebo Comparator: Control<br>Control Group: 15 healthy volunteers, athletes. | Device: Proprioception measurement on isokinetic dynamometer<br>* Proprioception measurement on isokinetic dynamometer using joint position sense (JPS) and the threshold to detection of passive motion (TTDPM)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline passive proprioceptive evaluation after 7 months | Measurement of knee proprioception by the passive repositioning technique (JPS, in degrees) on isokinetic dynamometer. | ACL group: 6 weeks after surgery and 7 months after surgery; Healthy group: one evaluation at a single point in time through study completion, an average of 1 year | 
| Change from Baseline active proprioceptive evaluation after 7 months | Measurement of knee proprioception by the active repositioning technique (JPS, in degrees) on isokinetic dynamometer. | ACL group: 6 weeks after surgery and 7 months after surgery; Healthy group: one evaluation at a single point in time through study completion, an average of 1 year | 
| Change from Baseline TDPM (Threshold to Detection of Passive Motion) evaluation after 7 months | Measurement of knee proprioception by the Threshold to Detection of Passive Motion (TDPM in degrees) on isokinetic dynamometer. | ACL group: 6 weeks after surgery and 7 months after surgery; Healthy group: one evaluation at a single point in time through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Strength | Measurement of knee extensors and flexors peak strength (in newton.meter, Nm) on isokinetic dynamometer. | ACL group: Two evaluations on both injured and healthy knees: (1) 3 months after surgery and (2) 7 months after surgery; Healthy group: one evaluation at a single point in time through study completion, an average of 1 year | 
| ACL-RSI questionnaire (Anterior Cruciate Ligament-Return to Sport after Injury) | The ACL-RSI measures the patient's understanding of his knee. It comprises 12 questions with a score of 1 to 10 for each | ACL group: Four evaluations on both injured and healthy knees: (1) 2 weeks before surgery, (2) 3 months after surgery, (3) 7 months after surgery and (4) 12 months after surgery | 
| Functional testing | Hop test. Single hop: Patients are instructed to stand on one leg and perform 1 jump as far as possible, landing on the same leg. The total distance is recorded (in cm) .Triple hop: Patients are instructed to stand on one leg and perform 3 hops as far as possible, landing on the same leg. The total distance for 3 consecutive hops is recorded (in cm). Cross-over hop test : The patient hops forward 3 times while alternately crossing over a marking The patient is instructed to position themselves such that the first of the 3 hops was lateral with respect to the direction of crossover The total distance hopped forward is recorded (in cm) | ACL group: Two evaluations on both injured and healthy knees: (1) 3 months after surgery and (2) 7 months after surgery; Healthy group: one evaluation at a single point in time through study completion, an average of 1 year |