Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3770–3779 | Cite as

Changes in the sensorimotor system and semitendinosus muscle morphometry after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study with 1-year follow-up

  • Marialuisa GandolfiEmail author
  • Matteo Ricci
  • Elena Sambugaro
  • Nicola Valè
  • Eleonora Dimitrova
  • Andrea Meschieri
  • Silvano Grazioli
  • Alessandro Picelli
  • Calogero Foti
  • Francesco Rulli
  • Nicola Smania



To evaluate the time course of sensorimotor integration processes involved in balance capability during 1-year follow-up after arthroscopic anterior cruciate ligament (ACL) reconstruction. To evaluate whether an association exists between balance performance and semitendinosus muscle morphometry features.


Twenty-seven patients (mean age 29.6 ± 10.8 years) were prospectively followed with stabilometry and ultrasound at 3 months (T0), 6 months (T1), and 1 year (T2) after arthroscopic ACL reconstruction. Body sway and sensorimotor integration processes were evaluated by calculating the percentage difference of sway (PDS) on two surface conditions.


A significant difference in PDS was observed over time (p < 0.001). The interaction “Time × Condition” showed significant differences (p = 0.02), with worse performance on the compliant than the firm surface. There was a significant difference in CSA (p < 0.001), MT (p < 0.001), and %HRD (p < 0.001) over time. The interaction “Time*side” was significant for CSA (p = 0.02) and %HRD (p = 0.01). A negative correlation between PDS on compliant surface and CSA was measured at 3- (r = − 0.71, n = 27, p < 0.001) and 6-month post-surgery (r = − 0.47, n = 27, p = 0.013).


Balance was regained within the first 6 months after surgery, while morphometry of the semitendinosus muscle improved mostly between 6 and 12 months in patients who returned to sports activities. Balance capabilities paralleled semitendinosus muscle morphometry improvements. The instrumental assessment of sensorimotor integration processes is relevant in clinical practice as screening tests for primary and secondary prevention of ACL injury.

Level of evidence

Prospective studies, Level II.


Sonoelastography Ultrasonography Gait Postural balance Proprioception 



The authors thank S. Bersani and F. Martinelli for their assistance in collecting data.

Author contributions

NS and MR have made substantial contributions to conception and design. MR and ES participated in the enrollment phase and carried out surgical procedures. ED and NV carried out the clinical assessment of balance performance and participated in the manuscript draft and revision process. MG and ES participated in the study design and coordination and statistical analysis. MG drafted the manuscripts and revision process. AM carried out US assessment. SG and AP participated in the enrollment procedures and were involved in rehabilitation phase implementation. NS, MR, CF, and RF participated in the manuscript revision and gave the final approval of the version.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

All procedures performed in the study were in accordance with ethical standards of the IIRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional review board approval for the study was provided (no. 1701N01A).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Marialuisa Gandolfi
    • 1
    • 2
    Email author
  • Matteo Ricci
    • 3
    • 4
  • Elena Sambugaro
    • 3
  • Nicola Valè
    • 1
  • Eleonora Dimitrova
    • 1
  • Andrea Meschieri
    • 1
  • Silvano Grazioli
    • 1
    • 4
  • Alessandro Picelli
    • 1
  • Calogero Foti
    • 5
  • Francesco Rulli
    • 5
  • Nicola Smania
    • 1
  1. 1.Department of Neuroscience, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC)University of VeronaVeronaItaly
  2. 2.UOC Neurorehabilitation, AOUI VeronaVeronaItaly
  3. 3.Department Surgery, Dentistry, Paediatrics and GynaecologyUniversity of VeronaVeronaItaly
  4. 4.Studio RehabVeronaItaly
  5. 5.Clinical Sciences and Translational Medicine DepartmentTor Vergata University RomeRomeItaly

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