Postural orientation in subjects with anterior cruciate ligament injury: development and first evaluation of a new observational test battery



Anterior cruciate ligament (ACL) injury is associated with mechanical instability and defective neuromuscular function, and can lead to further injury, increased joint loading and osteoarthritis. Patients with ACL injury demonstrate altered postural orientation, manifested as observable “substitution patterns” (SPs) but no one has applied a clinically useful method to systematically study postural orientation in these patients. Here, we investigated the presence of such patterns in 24 adults with ACL injury and in 49 controls, in parallel with the development and a first evaluation of a new test battery, test for SPs. The rationale behind the test for SPs was to characterize postural orientation as the ability to maintain appropriate relationships between body segments and environment during weight-bearing movements. In this first study, patients displayed SPs more frequently and/or more clearly on their injured, but also their uninjured side than did controls. Inter-rater and intra-rater reproducibility was good at a group level. Future studies of validity, responsiveness and including other subgroups of patients with ACL injury will have to prove if the test for SPs can be used in the diagnostics of defective neuromuscular function following knee injury, when planning and carrying out training and rehabilitation and when deciding appropriate time to return to activity and sports after ACL injury.


Anterior cruciate ligament Postural balance Weight-bearing Task performance Analysis Motor skills Reproducibility of findings 



The authors are very grateful to late Dr. RTP Rose Zätterström, who designed the first version of the TSP. We are also very grateful to Dr. Jonas Björk for expert advice on statistics, to Associate Professor Anders Lindstrand and to Professor Jan Lexell for valuable contributions to design and acquisition of data in the early stages of the study. This work was supported by the Swedish National Centre for Research in Sports, Region Skåne, Ann-Mari and Ragnar Hemborg’s Research Foundation and by the Faculty of Medicine, Lund University, Sweden. Anna Trulsson and Martin Garwicz were funded by the Swedish Research Council, Projects no. 14015 (PI Martin Garwicz) and 60012701 (a Linné grant to the Neuronano Research Center), respectively.

Conflict of interest statement

The authors report no conflict of interest for this manuscript.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Health Sciences, Division of Physical TherapyLund UniversityLundSweden
  2. 2.Unit for Specialized Pain Rehabilitation, Department of RehabilitationLund University HospitalLundSweden
  3. 3.Neuronano Research Center, Department of Experimental Medical ScienceLund UniversityLundSweden
  4. 4.Department of Orthopedics, Clinical SciencesLund UniversityLundSweden

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