Postural stability during visual-based cognitive and motor dual-tasks after ACLR

J Sci Med Sport. 2021 Feb;24(2):146-151. doi: 10.1016/j.jsams.2020.07.008. Epub 2020 Jul 28.


Objectives: Determine the effect of visual-based motor and cognitive dual tasking on postural stability in those with anterior cruciate ligament reconstruction relative to matched controls.

Design: Cohort study.

Methods: Fourteen volunteers with history of anterior crucaite ligament reconstruction were matched with fourteen healthy controls. Participants performed single leg balance tasks under 4 conditions: (1) single leg balance with eyes-open, (2) single leg balance while catching a ball (dual-motor), (3) single leg balance while repeating a string of numbers in reverse order after viewing them (dual-cognitive) and (4) single leg balance with eyes-closed. Participants completed several patient-reported outcomes of knee function. Mixed effects models were used to identify group differences on the center of pressure measures of ellipse area and root-mean-squared excursion (medial-lateral and anterior-posterior). The mixed models included subject pair as a random factor and group (control, anterior cruciate liagement reconstruction), balance condition (eyes-open, eyes-closed, dual-cognitive, and dual-motor), and group*condition as fixed effects. Tukey post-hoc pairwise comparisons were performed for significant interaction and main effects with an α=0.05.

Results: A significant group by condition interaction was observed for ellipse area and medial-lateral root-mean-squared excursion. The anterior cruciate ligament reconstruction group had higher ellipse area (p=0.002, d=0.44) and medial-lateral root-mean-squared excursion (p<0.001, d=0.49).

Conclusions: Postural stability is greatly impaired under eyes-closed and dual-motor conditions relative to eyes-open. Anterior cruciate ligament reconstructed individuals have greater postural instability during the dual-cognitive condition that may indicate unique neural processing deficits remain following anterior cruciate ligament reconstruction.

Keywords: ACL; Motor control; Return to sport.

MeSH terms

  • Anterior Cruciate Ligament Injuries / physiopathology*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Case-Control Studies
  • Cognition / physiology*
  • Female
  • Humans
  • Male
  • Motor Skills / physiology*
  • Patient Reported Outcome Measures
  • Postural Balance / physiology*
  • Return to Sport
  • Task Performance and Analysis
  • Visual Perception / physiology*
  • Young Adult