Residual Postural-Control Differences After Anterior Cruciate Ligament Reconstruction: Dual-Task Postural Control and Associations with Time Since Return to Sport
8 affiliations
- 1Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
- 2Department of Orthopedic Surgery, College of medicine, King Saud University, Riyadh 11461, Saudi Arabia
- 3Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61423, Saudi Arabia
- 4Physical Therapy for Musculoskeletal Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- 5Department of Surgery, College of Medicine, Najran University, Najran 11001, Saudi Arabia
- 6Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- 7Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Sakaka 72388, Saudi Arabia
- 8Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
Abstract
Background/Objectives: Residual sensorimotor deficits may persist after anterior cruciate ligament reconstruction (ACLR), even after clearance for unrestricted sport. This study compared unilateral postural control between individuals after ACLR and healthy controls under visual deprivation and cognitive dual-task conditions and examined associations between dual-task cost and time since reconstruction and return to activity. Methods: This cross-sectional study included 35 physically active adults 9–24 months after primary unilateral ACLR and 35 age-, sex-, body mass index-, and activity-matched controls. Force-platform posturography measured center-of-pressure (COP) path length, ellipse area, and mean velocity during unilateral stance with eyes open, eyes closed, and concurrent serial subtraction. COP path-length dual-task cost (DTC) was compared between groups and limbs. Correlation and multiple linear regression analyses examined associations with postoperative and return-to-activity duration. Results: Eyes-closed COP path length was greater in reconstructed limbs than in control reference limbs (720.00 ± 118.00 versus 552.00 ± 92.00 mm; p < 0.001). Reconstructed-limb DTC exceeded control reference-limb DTC (17.45 ± 10.20% versus 6.97 ± 6.80%; p < 0.001; Cohen’s d = 1.21) and contralateral-limb DTC (11.00 ± 8.40%; p < 0.001). Longer time since ACLR (r = −0.38; p = 0.024) and return to unrestricted activity (r = −0.44; p = 0.008) were associated with lower DTC. Both associations remained significant in a two-predictor regression model (adjusted R2 = 0.20). Conclusions: Postural-control differences persisted after ACLR despite clearance for unrestricted activity and were more evident under visual deprivation and cognitive loading. These cross-sectional associations support further investigation of dual-task posturography in postoperative assessment. The clinical significance and predictive value of these static posturographic measures for return-to-sport readiness and subsequent injury risk remain to be established.
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BibTeX
@article{alshehri2026residual,
title = {{Residual Postural-Control Differences After Anterior Cruciate Ligament Reconstruction: Dual-Task Postural Control and Associations with Time Since Return to Sport}},
author = {Shaker Hassan S. Alshehri and Nizar Algarni and Batool Abdulelah Alkhamis and Ghada Mohamed Koura and Ahmed Mohamed Fathi Elshiwi and Saleh M. Kardm and Amal Awad Saeed Alqahtani and Ravi Shankar Reddy and Ajay Prashad Gautam and Zeinab A. Ali and Maram Y. Al Ahmari},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218699},
url = {https://www.mdpi.com/2077-0383/15/21/8699},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Residual Postural-Control Differences After Anterior Cruciate Ligament Reconstruction: Dual-Task Postural Control and Associations with Time Since Return to Sport
AU - Shaker Hassan S. Alshehri
AU - Nizar Algarni
AU - Batool Abdulelah Alkhamis
AU - Ghada Mohamed Koura
AU - Ahmed Mohamed Fathi Elshiwi
AU - Saleh M. Kardm
AU - Amal Awad Saeed Alqahtani
AU - Ravi Shankar Reddy
AU - Ajay Prashad Gautam
AU - Zeinab A. Ali
AU - Maram Y. Al Ahmari
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218699
UR - https://www.mdpi.com/2077-0383/15/21/8699
AB - Background/Objectives: Residual sensorimotor deficits may persist after anterior cruciate ligament reconstruction (ACLR), even after clearance for unrestricted sport. This study compared unilateral postural control between individuals after ACLR and healthy controls under visual deprivation and cognitive dual-task conditions and examined associations between dual-task cost and time since reconstruction and return to activity. Methods: This cross-sectional study included 35 physically active adults 9–24 months after primary unilateral ACLR and 35 age-, sex-, body mass index-, and activity-matched controls. Force-platform posturography measured center-of-pressure (COP) path length, ellipse area, and mean velocity during unilateral stance with eyes open, eyes closed, and concurrent serial subtraction. COP path-length dual-task cost (DTC) was compared between groups and limbs. Correlation and multiple linear regression analyses examined associations with postoperative and return-to-activity duration. Results: Eyes-closed COP path length was greater in reconstructed limbs than in control reference limbs (720.00 ± 118.00 versus 552.00 ± 92.00 mm; p < 0.001). Reconstructed-limb DTC exceeded control reference-limb DTC (17.45 ± 10.20% versus 6.97 ± 6.80%; p < 0.001; Cohen’s d = 1.21) and contralateral-limb DTC (11.00 ± 8.40%; p < 0.001). Longer time since ACLR (r = −0.38; p = 0.024) and return to unrestricted activity (r = −0.44; p = 0.008) were associated with lower DTC. Both associations remained significant in a two-predictor regression model (adjusted R2 = 0.20). Conclusions: Postural-control differences persisted after ACLR despite clearance for unrestricted activity and were more evident under visual deprivation and cognitive loading. These cross-sectional associations support further investigation of dual-task posturography in postoperative assessment. The clinical significance and predictive value of these static posturographic measures for return-to-sport readiness and subsequent injury risk remain to be established.
SN - 2077-0383
ER -