Comparison between Nintendo Wii Fit and conventional rehabilitation on functional performance outcomes after hamstring anterior cruciate ligament reconstruction: prospective, randomized, controlled, double-blind clinical trial

  • Gul BaltaciEmail author
  • Gulcan Harput
  • Bunyamin Haksever
  • Burak Ulusoy
  • Hamza Ozer



The aim of this prospective, randomized, controlled, double-blind clinical trial was to compare the outcomes, including knee strength, balance, coordination, proprioception and response time, of Nintendo Wii Fit with those of conventional rehabilitation on the subjects with anterior cruciate ligament reconstruction.


Thirty volunteer subjects were enrolled in either Wii Fit (n = 15; mean age, 29 ± 7 years) or conventional rehabilitation (n = 15; mean age, 29 ± 6 years) programmes from the first week up to 12th weeks of the operation. Endoscopic reconstruction of a completely ruptured ACL was performed by using graft harvested from hamstrings. Each subject underwent an individual therapeutic programme. Functional examinations included the measurements of the balance using modified star excursion balance test, coordination, proprioception and response time using functional squat system and strength of flexor and extensor muscles of the involved and uninvolved leg using an isokinetic machine.


There was no significant difference between Wii Fit and conventional group in terms of isokinetic knee strength at 12th week, and dynamic balance, and functional squat tests including coordination, proprioception and response time at first, 8th and 12th weeks of the rehabilitation.


Two different 12-week-physiotherapy programmes following ACL reconstruction have the same affect on muscle strength, dynamic balance and functional performance values in both groups. We considered that the practice of Wii Fit activities like conventional rehabilitation could also address physical therapy goals, which included improving visual–perceptual processing, coordination, proprioception and functional mobility.

Level of evidence

Randomized, controlled trials with adequate statistical power, Level I.


Strength Balance Proprioception Coordination ACL Rehabilitation 


  1. 1.
    Aune A, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction: a randomized study with two-year follow-up. Am J Sports Med 29(6):722–728PubMedGoogle Scholar
  2. 2.
    Betker AL, Szturm T, Moussavi ZK, Nett C (2007) Video game- based exercises for balance rehabilitation: a single-subject design. Arch Phys Med Rehabil 87:1141–1149CrossRefGoogle Scholar
  3. 3.
    Bjorklund K, Skold C, Andersson L, Dalen N (2006) Reliability of a criterion-based test of athletes with knee injuries; where the physiotherapist and the patient independently and simultaneously assess the patient’s performance. Knee Surg Sports Traumatol Arthrosc 14:165–175PubMedCrossRefGoogle Scholar
  4. 4.
    Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M (2010) Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture 31:307–310PubMedCrossRefGoogle Scholar
  5. 5.
    Clark RA, McGough R, Paterson K (2011) Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards. Gait Posture 34(2):288–291PubMedCrossRefGoogle Scholar
  6. 6.
    Cooper RL, Taylor NF, Feller JA (2005) A systematic review of the effect of proprioceptive and balance exercises on people with an injured or reconstructed anterior cruciate ligament. Res Sports Med 13(2):163–178PubMedCrossRefGoogle Scholar
  7. 7.
    de Jong S, Van Caspel D, van Haeff M, Saris DBF (2007) Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 23(1):21–28PubMedGoogle Scholar
  8. 8.
    Decoster L, Labore, LL, Boquiren, ML, Russell, PJ (2008) Monitored rehab functional squat coordination test: reliability, learning curve and eccentric-concentric performance comparisons.
  9. 9.
    Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P (2008) Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Phys Ther 88(10):1196–1207PubMedCrossRefGoogle Scholar
  10. 10.
    Gil-Gomez JA, Llons R, Alcaiz M, Colomer C (2011) Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in subjects with acquired brain injury. J Neuroeng Rehabil 23(8):30. doi: 10.1186/1743-0003-8-30 CrossRefGoogle Scholar
  11. 11.
    Graves LE, Ridgers ND, Stratton G (2008) The contribution of upper limb and total body movement to adolescents’ energy expenditure whilst playing Nintendo Wii. Eur J Appl Physiol 104:617–623PubMedCrossRefGoogle Scholar
  12. 12.
    Herrington L, Hatcher J, Hatcher A, McNicholas M (2009) A comparison of Star Excursion Balance Test reach distances between ACL deficient subjects and asymptomatic controls. Knee 16(2):149–152PubMedCrossRefGoogle Scholar
  13. 13.
    Hertel J, Miller S, Denegar C (2000) Intratester and intertester reliability during the star excursion balance test. J Sport Rehabil 9:104–116Google Scholar
  14. 14.
    Jamshidi AA, Olyaei GR, Heydarian K, Talebian S (2005) Isokinetic and functional parameters in patients following reconstruction of the anterior cruciate ligament. Isokinet Exerc Sci 13:267–272Google Scholar
  15. 15.
    Järvelä T, Kannus P, Latvala K, Järvinen M (2002) Simple measurements in assessing muscle performance after an ACL reconstruction. Int J Sports Med 23:196–201PubMedCrossRefGoogle Scholar
  16. 16.
    Kinzey SJ, Armstrong CW (1998) The reliability of the star excursion balance test in assessing dynamic balance. J Orthop Sports Phys The 27:356–360Google Scholar
  17. 17.
    Lange B, Flynn S, Proffitt R, Chang CY, Rizzo A (2010) Development of an interactive game-based rehabilitation tool for dynamic balance training. Top Stroke Rehabil 17(5):345–352PubMedCrossRefGoogle Scholar
  18. 18.
    Lautamies R, Harilainen A, Kettunen J, Sandelin J, Kujala UM (2008) Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 16:1009–1016PubMedCrossRefGoogle Scholar
  19. 19.
    Laver K, Ratcliffe J, George S, Burgess L, Crotty M (2011) Is the Nintendo Wii Fit really acceptable to older people? A discrete choice experiment. BMC Geriatr 20(11):64CrossRefGoogle Scholar
  20. 20.
    Laver KE, George S, Thomas S, Deutsch JE, Crotty M (2011) Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev 9:CD008349Google Scholar
  21. 21.
    Maffiuletti NA, Bizzini M, Schatt S, Munzinger U (2005) A multi-joint lower-limb tracking-trajectory test for the assessment of motor coordination. Neurosci Lett 384:106–111PubMedCrossRefGoogle Scholar
  22. 22.
    Meldrum D, Glennon A, Herdman S, Murray D, McConn-Walsh R (2012) Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii(®) Fit Plus. Disabil Rehabil: Assist Technol 7(3):205–210CrossRefGoogle Scholar
  23. 23.
    Monitored Rehab Systems Software-MRS-E0701 Guidelines (2006) pp 74–97Google Scholar
  24. 24.
    Narducci E, Waltz A, Gorski K, Leppla L, Donaldson M (2011) The clinical utility of functional performance tests within one-year post-ACL reconstruction: a systematic review. Int J Sports Phys Ther 6(4):333–342PubMedGoogle Scholar
  25. 25.
    Plisky PJ, Gorman PP, Butler RJ, Underwood FB, Elkins B et al (2009) The reliability of an instrumented device for measuring components of the star excursion balance test. Am J Sports Phys Ther 4(2):92–99Google Scholar
  26. 26.
    van Grinsven S, van Cingel REH, Holla CJM, vanLoon CJM (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1128–1244PubMedCrossRefGoogle Scholar
  27. 27.
    Weiss PL, Rand D, Katz N, Kizony R (2004) Video capture virtual reality as a flexible and effective rehabilitation tool. J Neuroeng Rehabil 1(1):12. doi: 10.1186/1743-0003-1-12 PubMedCrossRefGoogle Scholar
  28. 28.
    Yosmaoglu HB, Baltaci G, Kaya D, Ozer H (2011) Tracking ability, motor coordination, and functional determinants after anterior cruciate ligament reconstruction. J Sport Rehabil 20(2):207–218PubMedGoogle Scholar
  29. 29.
    Yosmaoglu HB, Baltaci G, Kaya D, Ozer H, Atay A (2011) Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft. Acta Orthop Traumatol Turc 45(4):240–247PubMedCrossRefGoogle Scholar
  30. 30.
    Yosmaoglu HB, Baltaci G, Ozer H, Atay A (2011) Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19(8):1287–1292PubMedCrossRefGoogle Scholar
  31. 31.
    Young W, Ferguson S, Brault S, Craig C (2011) Assessing and training standing balance in older adults: a novel approach using the ‘Nintendo Wii’ Balance Board. Gait Posture 33:303–305PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Gul Baltaci
    • 1
    Email author
  • Gulcan Harput
    • 1
  • Bunyamin Haksever
    • 1
  • Burak Ulusoy
    • 1
  • Hamza Ozer
    • 2
  1. 1.Department of Physiotherapy and Rehabilitation, Faculty of Health SciencesHacettepe UniversityAnkaraTurkey
  2. 2.Department of Orthopedics and Traumatology, Faculty of MedicineGazi UniversityAnkaraTurkey

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