RecruitingACTRN12624001445561

Effect of Upper Limb Isometric Training on Hamstring Strength after Anterior Cruciate Ligament Reconstruction

Effect of Upper Limb Isometric Training on Hamstring Strength in Early Postoperative Anterior Cruciate Ligament Reconstruction Patients: A Randomised Controlled Trial

Sponsor

Hospital Canselor Tuanku Muhriz UKM

Enrollment

32 participants

Start Date

Jan 2, 2025

Study Type

Interventional

Conditions

Anterior Cruciate Ligament Reconstruction (ACLR)

Summary

This study examines the effects of combining upper limb isometric training (ULIT) with standard care in an anterior cruciate ligament reconstruction (ACLR) rehabilitation program on hamstring strength and physical function during the early postoperative period. Hamstring strength deficits can lead to functional limitations and an increased risk of secondary injuries. We hypothesise that participants receiving ULIT in addition to standard care will demonstrate better hamstring strength at 12 weeks post-operatively compared to those receiving standard care rehabilitation alone. The study will randomly assign 32 patients to either an intervention group (receiving ULIT plus standard care) or a control group (receiving standard postoperative rehabilitation only). The primary outcome will be the change in hamstring strength in the operated limb at 12 weeks post-ACLR, while secondary outcomes will include hamstring flexibility and patient-reported outcomes on symptoms, physical function, and adherence. The findings will contribute to understanding the global functional muscle concept, suggest safe, effective, and cost-efficient interventions, and encourage further exploration of interlimb muscle activation and flexibility in heterologous muscle groups following ACLR.

Eligibility

Sex: Both males and femalesMin Age: 18 YearssMax Age: 45 Yearss

Plain Language Summary

Simplified for easier understanding

Tearing the anterior cruciate ligament (ACL) in the knee is a common and often painful injury, frequently requiring reconstructive surgery followed by months of rehabilitation. One of the key challenges after ACL reconstruction is that the hamstring muscles — which are often used as donor tissue for the reconstruction — can become significantly weaker, increasing the risk of re-injury and slowing recovery. This study is investigating whether adding upper limb isometric training (exercises using the arms and hands without movement) to a standard rehabilitation programme can help improve hamstring strength and physical function in the operated leg. The idea is based on the concept that training one part of the body can have beneficial effects on other parts through neural connections — a principle called the global functional muscle concept. Half of participants will receive standard rehabilitation alone, and half will also receive the upper limb training. You may be eligible if you are aged 18 to 45 years, are planning to have ACL reconstruction surgery using a hamstring tendon graft from your own knee, and are able to understand English and give consent. People having their second ACL surgery, or those with injuries to multiple knee ligaments, would not be eligible.

This summary was AI-generated to explain the trial in plain language. It is not medical advice. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

The intervention group will participate in the Upper Limb Isometric Training (ULIT) alongside the standard care rehabilitation program. Participants will follow the standard care rehabilitation as outpatients from week 1 post-ACLR and the prescribed home exercise program. Starting in week 4 and continuing through week 12 post-ACLR, participants will integrate the ULIT into their warm-up and home exercise program in addition to standard ACLR rehabilitation, approximately lasting an hour per session. A physiotherapist with more than five years of clinical experience will administer the ULIT program to participants following anterior cruciate ligament reconstruction (ACLR) surgery at an outpatient physiotherapy clinic. This will involve verbal instructions, demonstrations, and written materials. The program includes three standing exercises—an isometric wall push-up, isometric shoulder extension, and isometric shoulder external rotation. General Exercise Instructions: Finding Suitable Walls and Floors: Use a sturdy wall, ideally made of concrete, brick, or drywall supported by a stud frame, and avoid any walls with sharp edges. This ensures stability under applied force. Floors should have excellent traction, such as rubber mats or non-slip tiles, to prevent slipping. Standing Position: Stand upright with feet shoulder-width apart. Maintain a neutral alignment of the lower back and hip, with knees fully extended and weight distributed evenly across both feet. Effort Level: Begin each exercise with 100% effort for the first repetition. Perform the remaining 5 repetitions at 50% of maximum effort. Repetition Structure: Hold each position for 5 seconds, followed by a 5-second rest. Complete a total of 5 repetitions per exercise. Perform 1 set of each exercise, 1–2 times daily. Rest: Allow the upper limb muscles to relax and step back slightly from the wall to rest for 1 minute before starting the next exercise. Additional adherence measures: Materials provided: Patients will receive an exercise pamphlet and an online exercise diary to facilitate adherence to the program. Self-reporting and monitoring: Participants are advised to follow the home exercise program guidelines included in their informational flyers. They will ask to complete a weekly exercise diary using an online Google Form. The physiotherapist will communicate with the participants weekly via phone or WhatsApp to reinforce adherence to the exercise program.

Locations(1)

Kuala Lumpur, Malaysia

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ACTRN12624001445561