ACL Reconstruction (ACLR) With a Bone-patellar Tendon-bone (BPTB) Autograft, Hamstring Muscle Strain
Conditions
Keywords
ankle sprain, reinjury, reactive strength
Brief summary
This randomized controlled trial compares criteria-based rehabilitation (CBR) with time-based rehabilitation (TBR) for football players aged 18-35 with ACL reconstruction, hamstring strain, or ankle sprain. Both groups receive a six-week supervised rehabilitation program; the progression rules differ between groups.
Detailed description
Eligible football players will be recruited from local football clubs and academies in Islamabad Capital Territory and Rawalpindi. Written informed consent will be obtained. Participants will be randomly allocated 1:1 using a concealed, computer-generated sequence. Baseline demographic, functional, and psychological measures will be collected. Both groups follow the same general phase-based rehabilitation structure under licensed physiotherapist supervision. CBR progression depends on objective functional and psychological milestones; TBR progression follows fixed time intervals and return-to-play clearance at week 6 irrespective of milestones. Progression is paused or regressed if pain is ≥4/10 on VAS or swelling returns.
Interventions
OTHERExperimental: Criteria based
* Weeks 1-2: Focus on pain control, ROM restoration, and isometric strengthening (low intensity, 3-4 sets of 10-15 reps). * Weeks 2-4: Closed-chain and eccentric strengthening (moderate intensity, 3 sets of 12-15 reps), balance training, and jogging once LSI ≥ 80%. * Weeks 4-6: Plyometrics, agility, sprinting, and football-specific drills (high intensity, 4-5 sets, 80-85% effort). Participants will only progress or return to play upon meeting the criteria: hop test LSI ≥ 90%, SEBT symmetry, improved ACLRSI,
OTHERActive comparator: Time based rehabilitation
Weeks 1-2: Pain reduction and early strengthening (low intensity, 3 sets of 10-12 reps). * Weeks 2-4: General strengthening, proprioception, and jogging (moderate intensity, 3 sets of 12-15 reps). * Weeks 4-6: Plyometrics, agility, sprinting, and football-specific drills (high intensity, 70-85% effort) All participants will be cleared for return to play at the end of Week 6, regardless of whether they have achieved functional or psychological milestones, reflecting a traditional time-driven rehabilitation approach. This design reflects conventional rehabilitation models used in previous comparative studies, in which exercise progression and RTP clearance are determined by elapsed time rather than by functional recovery.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Injury Type: ACL reconstruction, hamstring strain, and ankle sprain. * Rehabilitation Phase: Phase 3 for ACL injuries, Phase 1\&2 for hamstring strains and ankle sprains. * Football Activity: Active at club or regional football level
Exclusion criteria
* History of Major surgery in affected limb * Chronic neurological or musculoskeletal disorder * Non-football athletes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hop battery test (single, triple, and crossover hop) including limb symmetry index (LSI) | At baseline, 0 weeks 6 weeks post-intervention | A tool to assess lower-limb strength, power, symmetry and functional performance in athletes post-injury; demonstrates good test-retest reliability (ICC ≈ 0.85-0.97) and valid discriminatory ability, though its capacity to predict re-injury remains inconsistent |
| Star Excursion Balance Test (SEBT/Y-Balance) | At Baseline After 6 weeks | Evaluates dynamic balance and postural control; high reliability (ICC 0.85-0.91) and validated in athletes |
| ACL-RSI (Return to Sport after Injury Scale) | At baseline After 6 weeks of intervention | Measures psychological readiness and fear of re-injury; strong internal consistency (α = 0.94) and test-retest reliability (ICC = 0.90) |
| Tampa Scale of Kinesiophobia (TSK) | at baseline at 6 weeks post intervention | Assesses fear of movement and re-injury; validated in musculoskeletal populations with good internal consistency (α = 0.810.87) and test-retest reliability (ICC = 0.84-0.90) |
| Landing Error Scoring System (LESS) | at baseline at 6 weeks post intervention | The LESS is a movement screen used to identify specific movement patterns of the lower extremities that may increase an individual's risk for noncontact ACL injury |
| Reactive Strength Index (RSI) | at baseline 6 weeks post intervention | Measures reactive strength and stretch-shortening cycle efficiency; demonstrates good test-retest reliability (ICC = 0.87) in athletes. |
Countries
Pakistan
Contacts
CONTACTSaadia Batool
CONTACTrida zafar
PRINCIPAL_INVESTIGATORRamsha Ali
Riphah International University
Outcome results
None listed