Disclosures. Y- Balance Testing in Anterior Cruciate Injuries and Following Reconstruction. Introduction. Study Funding:

Transcription

1 Y- Balance Testing in Anterior Cruciate Injuries and Following Reconstruction Brian Lau 1 MD, Lauren Tufts 2 BS, Richard Souza 2 DPTPhD, Xiaojuan Li 2 PhD, Brian Feeley 1 MD, Christina Allen 1 MD, C. Benjamin Ma 1 MD 1. UCSF Department of Orthopaedic Surgery. 2. UCSF Department of Radiology and Biomedical Imaging. Disclosures Lau, Tufts, Souza, Li, Feeley, Allen: No Disclosures Ma: Educational support from Zimmer Research support from Zimmer, Histogenics, Moximed Study Funding: AOSSM Genzyme Osteoarthritis Grant for Clinical Research NIH/NIAMS P5 AR752 P5 ACL Study Prospective Study of 5 patients with ACL injury Study to investigate changes in cartilage health using quantitative imaging, knee kinematics using quantitative MR imaging and kinetic testing using motion analysis and functional evaluations Longitudinal ACL observational study at baseline (after injury), then 6 months, 1 year, 2 years, and 3 years (after reconstruction) Goal is to understand the natural history of posttraumatic arthritis following ACL injury and reconstruction and identifying ways to recognize patients earlier in the time course ACL injuries are common ACL-deficient (D) knee leads to instability Instability related to balance ---> postural control and functional performance Balance testing may be able to assess functional deficits in ACL-D knees and recovery after reconstruction 1

2 Static Balance testing has been criticized as not sufficiently challenging enough for physically active patients Star Excursion Balance Testing (SEBT) is a dynamic test that requires strength, flexibility, and proprioception Shown to be reliable measure that sufficiently challenges active patients Used identify chronic ankle instability, assess physical performance, and identify athletes at greater risk of lower extremity injury Star Excursion Balance Test uses 8 different positions for each leg Y-Balance testing: 3 of 8 Positions Equally Effective Improved efficiency and repeatability Intrarater reliability Interrater reliabilty Purpose and Hypothesis Baseline (after ACL injury and prior to reconstruction) - Purpose: To evaluate balance in ACL-D knees, contralateral knees, and healthy controls -Hypothesis: ACL-D patients will have less balance compared to contralateral knees and healthy controls 6 Months (after ACL reconstruction) - Purpose: To evaluate affect of ACL reconstruction on balance and relationship of Y-balance with other functional tests - Hypothesis: ACL reconstruction will improve balance and Y-balance will correlate with other functional testing 2

3 Methods Baseline ACL-D 6 Months ACL-R Healthy Controls N Age (yrs) / / / BMI (kg/m2) / / /- 1.9 Male/Female 24/21 17/14 8/6 Time from injury to baseline evaluation (days) Time from surgery to evaluation (days) / days / days Exclusion Criteria: Other ligamentous injuries, meniscal injury requiring repair, previous history of arthritis, knee trauma, or surgery. 1) All patients underwent Y-balance testing- 3 trials (Max) 2) Max Recorded value taken and normalized by leg length 3) Trials done for each leg 4) At 6 months (distance) and 6-meter Timed (time) was performed Baseline ACL-D Knee vs Contralateral Knee vs Healthy Control Knee *2.76 * * * * ACL-D Healthy Controls Contralateral Smallest Detectable ACL-D knee and Contralateral Knee have similar reach and have less reach in Posterior Medial and Posterior Lateral direction compared to Healthy Controls 6 Months ACL-R Knee vs Contralateral Knee vs Healthy Control Knee *3.39 ACL-R Healthy Controls Contralateral Smallest Detectable 6 months following ACL reconstruction and rehabilitation reach for ACL-R knee and Contralateral knee are similar and match Healthy Controls ACL-Injured Knee Longitudinal Baseline to 6 Months Following Reconstruction *3.7 * *4.9 Baseline 6 Months Smallest Detectable Posterior-Medial significantly improved and meet Smallest Detectable Difference 3

4 Contralateral knee Longitudinal Baseline to 6 Months Following Reconstruction *2.61 * *6.68 Baseline 6 Months Smallest Detectable Posterior-Medial significantly improved and meet Smallest Detectable Difference 6 Months Y-Balance Test Correlation with Single Leg and 6-Meter Anterior Posterior- Medial Posterior- Lateral ACL-R Knees Contralateral Knees Healthy Control Knees (N=22) (N=22) (N=31) (N=31) (N=28) (N=28) R=.52* R= -.* R=.44* R= -.31 R=.34 R= -.57* R=.62* R= -.54* R=.46* R= -.32* R=.44* R= -.62* R=.47* R= -.5* R=.49* R= -.56* R=.57* R= -.75* Reconstructed, Contralateral, Healthy knees: Longer Y-Balance Correlates with Longer Distance and Shorter 6-Meter Time Discussion Herrington et al demonstrated with Y-balance testing that ACL deficient and Contralateral knees had similar reach and less than healthy controls at mean 11 months after injury. Our study is unique as it follows patients before and after ACL Reconstruction and demonstrates return of balance function at mean 8 months after injury (6 months after reconstruction) and we demonstrate that Y-balance testing correlates with other functional tests Y-Balance testing may be a safe and cost effective way to assess functional deficits and recovery for ACL injuries References 1) Bollen s. Epidemiology of knee injuries: diagnosis and triage. Brit J sports Med ;34: ) Barret D, Cobb A, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Jt surg 1991; 73-B: ) Lephart S, Fu F. The role of proprioception in the treatment of sports injuries. Sports Sci Inj 1995;1: ) Friden T, Zatterstrom R, Lindstrand A, Moritz U. Anterior-cruciate-insufficient knees treated with physiotherapy. Clin Orthop Relat Res 1;262: ) Gribble PA, Hertel J, Plisky P. Using the Star Excusion Balance Test to Assess Dynamic Postural-Control Deficits and Outcomes in Lower Extremity Injury: A Literature and Systemic Review. J Ath Training 12;47(3): ) Hertel J, Miller J, Denegar C. Intratester and intertester reliability during Star Excursion Balance Tests. J Sport Rehabil ; 9: ) Kinzey S, Armstrong C. The reliability of the star excursion test in assessing dynamic balance. J Orthop Sports Phys Ter 1998; 27: ) Herrington L et al. A Comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. The Knee. 9.16; ) Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins B. The reliability of an instrumented device for measuring components of the star excursion balance test. N Am J Sports Phys Ther. 9 May; 4(2):

5 Acknowledgements C. Benjamin Ma, MD Richard Souza, PT PhD Brian Feeley, MD Christina Allen, MD Lauren Tufts, BS Drew Lansdown, MD Musa Zaid, B.S. Xiaojuan Li, PhD UCSF Orthopedic Surgery Residents UCSF Department of Orthopaedic Surgery Musculoskeletal Quantitative Imaging Group UCSF Department of Radiology Funding: AOSSM Genzyme Osteoarthritis Grant for Clinical Research NIH/NIAMS P5 AR752 5