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Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

Background
Proprioceptive training in the aquatic environment is more beneficial owing to water properties. The primary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquatic proprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and joint position sense in male athletes after anterior cruciate ligament reconstruction (ACLR).


Methods
A total of 38 athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. The conventional therapy group (CT) (n=19) received conventional rehabilitation for 6 weeks, while the hydrotherapy group (HT) (n=19) received the same conventional rehabilitation, in addition to 12 sessions of innovative aquatic proprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), and international knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was used to compare the means between the two groups. Cohen's d from an independent t-test was used to calculate the effect sizes for all variables after the intervention for both groups.


Results
Base on the results, there were a significant difference in absolute errors (AE) (FAE=56.231, P<0.001) and variable errors (VE) (FVE=60.245, P<0.001) between the two groups. No significant differences were detected in constant error (CE), VAS, and IKDC between the two groups (P>0.05). Both groups displayed a significant difference in terms of AE, VE, VAS, and IKDC after the intervention (P<0.05). Percent changes after the intervention for AE(69.19%), VE (68.20%), CE (65.20%), VAS37.50%, and IKDC (38.61%) were greater in the HT group, compared to the CT group.


Conclusion
As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into the conventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individuals with ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensure the optimal engagement of proprioception.