Development of dynamic knee stability after acute ACL injury

Recently, a training program that includes perturbation of support surfaces has been shown to allow most active individuals with ACL injury who pass a screening examination to successfully return to high level activities. The purpose of this study was to identify the effect of this rehabilitation program on involved side muscle activation during walking in subjects with acute ACL rupture and to determine if the activation changes were coincident with improved function. Nine subjects with an acute, unilateral ACL injury or rupture of an ACL graft, who met the screening examination criteria, received ten sessions of rehabilitation that included perturbation training. Motion analysis of five self-paced walking trials were performed before and after training. Electromyographic (EMG) data were collected during stance. After training during walking, the vastus lateralis (VL) integral of activity increased, and relationships between muscles were significantly altered. During walking, VL activation variables were dependent on lateral hamstrings (LH) and/or the soleus (SOL) activation, while no relationships were found before training. Function improved after training, and all subjects returned to their pre-injury activities without experiencing instability. The relationships formed between muscles post-training suggests that perturbation training enhances dynamic knee stability by inducing a well-coordinated strategy among muscles that affect tibial translation.