Disclosures Y- Balance Testing in Anterior Cruciate Lau, Tufts, - - PowerPoint PPT Presentation

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Y- Balance Testing in Anterior Cruciate Injuries and Following Reconstruction

Brian Lau1 MD, Lauren Tufts2BS, Richard Souza2 DPTPhD, Xiaojuan Li2 PhD, Brian Feeley1 MD , Christina Allen1 MD , C. Benjamin Ma1 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 P50 AR060752

P50 ACL Study

• Prospective Study of 50 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 post-

traumatic arthritis following ACL injury and reconstruction and identifying ways to recognize patients earlier in the time course

Introduction Purpose & Hypothesis Methods Results Discussion

Introduction

• 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

Introduction Purpose & Hypothesis Methods Results Discussion

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Introduction

• 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

Introduction Purpose & Hypothesis Methods Results Discussion

Introduction

Introduction Purpose & Hypothesis Methods Results Discussion

• Star Excursion Balance Test uses 8 different

positions for each leg

Introduction

Introduction Purpose & Hypothesis Methods Results Discussion

• Y-Balance testing:

– 3 of 8 Positions – Equally Effective – Improved efficiency and repeatability – Intrarater reliability 0.85-0.91 – Interrater reliabilty 0.99-1.0

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

Introduction Purpose & Hypothesis Methods Results Discussion

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Methods

Introduction Purpose & Hypothesis Methods Results Discussion

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 Single Leg Jump (distance) and 6-meter Timed Hop (time) was performed

Baseline ACL-D 6 Months ACL-R Healthy Controls N 45 31 14 Age (yrs) 29.2 +/- 8.7 29 +/- 8.6 30.3 +/.- 5.1 BMI (kg/m2) 23.7 +/- 2.8 23.9 +/- 2.8 23.4 +/- 1.9 Male/Female 24/21 17/14 8/6 Time from injury to baseline evaluation (days) 53.65 +/- 35.2 days Time from surgery to evaluation (days) 189.16 +/- 30.38 days Exclusion Criteria: Other ligamentous injuries, meniscal injury requiring repair, previous history of arthritis, knee trauma, or surgery.

20 40 60 80 100 120 140 Anterior PM PL ACL-D Healthy Controls Contralateral

Baseline ACL-D Knee vs Contralateral Knee vs Healthy Control Knee

Introduction Purpose & Hypothesis Methods Results Discussion * Indicates p < 0.05

ACL-D knee and Contralateral Knee have similar reach and have less reach in Posterior Medial and Posterior Lateral direction compared to Healthy Controls

Reach Distance (% leg length) * * Smallest Detectable Difference: Anterior= 6.87 PM= 8.15 PL=7.11 * * *2.76

6 Months ACL-R Knee vs Contralateral Knee vs Healthy Control Knee

Introduction Purpose & Hypothesis Methods Results Discussion * Indicates p < 0.05 Reach Distance (% leg length) Smallest Detectable Difference: Anterior= 6.87 PM= 8.15 PL=7.11 *3.39

6 months following ACL reconstruction and rehabilitation reach for ACL-R knee and Contralateral knee are similar and match Healthy Controls

20 40 60 80 100 120 140 Anterior PM PL ACL-R Healthy Controls Contralateral 20 40 60 80 100 120 140 Anterior PM PL Baseline 6 Months

ACL-Injured Knee Longitudinal Baseline to 6 Months Following Reconstruction

Introduction Purpose & Hypothesis Methods Results Discussion

Posterior-Medial Reach significantly improved and meet Smallest Detectable Difference

*3.07 * *4.9 Reach Distance (% leg length) Smallest Detectable Difference: Anterior= 6.87 PM= 8.15 PL=7.11 * Indicates p < 0.05

5/9/2014 4 Contralateral knee Longitudinal Baseline to 6 Months Following Reconstruction

Introduction Purpose & Hypothesis Methods Results Discussion

Posterior-Medial Reach significantly improved and meet Smallest Detectable Difference

20 40 60 80 100 120 140 Anterior PM PL Baseline 6 Months

*2.61 * *6.68 Reach Distance (% leg length) Smallest Detectable Difference: Anterior= 6.87 PM= 8.15 PL=7.11 * Indicates p < 0.05

6 Months Y-Balance Test Correlation with Single Leg Jump and 6-Meter Hop

Introduction Purpose & Hypothesis Methods Results Discussion

Reconstructed, Contralateral, Healthy knees: Longer Y-Balance Reach Correlates with Longer Single Leg Jump Distance and Shorter 6-Meter Hop Time

Single Leg Jump (N=22) 6 Meter Hop (N=22) Single Leg Jump (N=31) 6 Meter Hop (N=31) Single Leg Jump (N=28) 6 Meter Hop (N=28) Anterior Reach R= 0.52* R= -0.40* R= 0.44* R= -0.31 R= 0.34 R= -0.57* Posterior- Medial Reach R= 0.62* R= -0.54* R= 0.46* R= -0.32* R= 0.44* R= -0.62* Posterior- Lateral Reach R= 0.47* R= -0.50* R= 0.49* R= -0.56* R= 0.57* R= -0.75* * Indicates p < 0.05 ACL-R Knees Contralateral Knees Healthy Control Knees

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

Introduction Purpose & Hypothesis Methods Results Discussion

References

1) Bollen s. Epidemiology of knee injuries: diagnosis and triage. Brit J sports Med 200;34:227- 8 2) Barret D, Cobb A, Bentley G. Joint proprioception in normal, osteoarthritic and replaced

• knees. J Bone Jt surg 1991; 73-B:53-6.

3) Lephart S, Fu F. The role of proprioception in the treatment of sports injuries. Sports Sci Inj 1995;1:96-102. 4) Friden T, Zatterstrom R, Lindstrand A, Moritz U. Anterior-cruciate-insufficient knees treated with physiotherapy. Clin Orthop Relat Res 1001;262:190-9. 5) 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 2012;47(3):339-357. 6) Hertel J, Miller J, Denegar C. Intratester and intertester reliability during Star Excursion Balance Tests. J Sport Rehabil 2000; 9:104-16. 7) Kinzey S, Armstrong C. The reliability of the star excursion test in assessing dynamic

• balance. J Orthop Sports Phys Ter 1998; 27:356-60.

8) Herrington L et al. A Comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls. The Knee. 2009.16;149-152 9) 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. 2009 May; 4(2):92-9.

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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 P50 AR060752