Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Background: Proprioceptive training in the aquatic environment is more beneficial owing to water properties. Theprimary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquaticproprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and jointposition sense in male athletes after anterior cruciate ligamen t reconstruction (ACLR).Methods: A total of ۳۸ athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. Theconventional therapy group (CT) (n=۱۹) received conventional rehabilitation for ۶ weeks, while the hydrotherapygroup (HT) (n=۱۹) received the same conventional rehabilitation, in addition to ۱۲ sessions of innovative aquaticproprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), andinternational knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was usedto compare the means between the two groups. Cohen’s d from an independent t-test was used to calculate theeffect sizes for all variables after the intervention for both gr oups.Results: Base on the results, there were a significant difference in absolute errors (AE) (FAE=۵۶.۲۳۱, p <۰.۰۰۱)and variable errors (VE) (FVE=۶۰.۲۴۵, p <۰.۰۰۱) between the two groups. No significant differences were detectedin constant error (CE), VAS, and IKDC between the two groups (P>۰.۰۵). Both groups displayed a significantdifference in terms of AE, VE, VAS, and IKDC after the intervention (p <۰.۰۵). Percent changes after the interventionfor AE(۶۹.۱۹%), VE (۶۸.۲۰%), CE (۶۵.۲۰%), VAS۳۷.۵۰%, and IKDC (۳۸.۶۱%) were greater in the HT group,compared to the CT group.Conclusion: As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into theconventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individualswith ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensurethe optimal engagement of proprioception.Level of evidence: I

Keywords:

ACL , aquatic exercises , Anterior cruciate ligament reconstruction , Hydrotherapy , Proprioception , Rehabilitation , sports injury