Functional Movement Competency and Dynamic Balance After Anterior Cruciate Ligament Reconstruction in Adolescent Patients

Background: Adolescent patients undergoing anterior cruciate ligament (ACL) reconstruction may not adequately recover safe movement patterns before returning to sport participation. The aims of this study were to assess functional movement and dynamic balance 9 months after primary ACL reconstruction in adolescent patients, and to assess for any maturity-specific differences that may guide rehabilitation strategies. Methods: A series of 39 adolescent patients who underwent primary, anatomic, transphyseal ACL reconstruction using hamstrings autograft from October 2009 to January 2013 were identified from a research database: 17 skeletally immature (SI) patients (mean age 13.6 +/- 1.6 y) and 22 skeletally mature (SM) patients (mean age 16.6 +/- 1.2 y). An adult reference population of 16 primary ACL reconstruction patients (mean age 27.4 +/- 4.0 y) was also identified. All patients followed a standardized operative and rehabilitation protocol. The 3 patient groups were compared 9 months postoperatively using the Functional Movement Screen (FMS) to assess movement competency and the Lower Quarter Y-Balance Test (LQYBT) to assess single-limb dynamic balance. Results: Nine months postoperatively, the FMS scores for all 3 groups indicated an increased risk for lower extremity injury (total score <= 14). With respect to specific movement patterns, the SI group displayed inferior active straight leg raise score (P = 0.006) despite a lower incidence of pain with this movement. With the LQYBT, there was no significant difference in mean anterior (P = 0.987), posterolateral (P = 0.349), or posteromedial (P = 0.870) reach asymmetry between the 3 groups; however, the adolescent groups demonstrated wider ranges of anterior reach asymmetry than the adult group indicating an increased risk for injury. Conclusions: Adolescent patients undergoing primary ACL reconstruction do not consistently recover adequate functional movement patterns by 9 months postoperatively to permit a safe return to sport. We have identified unique functional movement deficits in SI and SM adolescents, which highlight the need for maturity-specific rehabilitation strategies for adolescent patients undergoing ACL reconstruction.