Plantar pressure distribution has potential to be an adjunct to predict return to sport after anterior cruciate ligament reconstruction: An observational study.

INTRODUCTION: The human foot plays an important role in the biomechanical function of the lower limb. Plantar pressure distribution (PPD) can be a useful way to gauge functional knee stability. The objective of the study was to determine whether PPD can be used as an objective criterion for return to sports post anterior cruciate ligament (ACL) reconstruction (ACLR).

METHODS: Over a period of 18 months, 54 symptomatic, MRI-confirmed, isolated ACL tear patients were enrolled in the study. Plantar pressure distribution was documented preoperatively and at 3, 4, 5, and 6 months postoperatively. International Knee Documentation Committee (IKDC) scoring and isometric strength testing of quadriceps and hamstrings were also done simultaneously.

RESULTS: 50 patients completed follow-up. IKDC score improved at all follow-ups. The forefoot PPD decreased, while the hindfoot PPD increased with statistically significant differences (p < 0.01) between both limbs up to 6 months. Reduced knee extension isometric strength was seen on the involved side with statistically significant differences (p < 0.01) between both limbs at all follow-up timelines. Twenty-seven participants were cleared to perform the advanced lower-extremity sports assessment (ALESA) return to sport test at 6 months. Participants with ALESA score ≥11 had statistically significantly higher hindfoot (p = 0.031) and lower forefoot pressures (p = 0.033) compared to those who did not.

CONCLUSION: PPD changes can guide dynamic functional assessment of patients with ACL tears and recovery patterns after ACL reconstruction. It has potential to be used as an adjunct criterion when determining readiness for return to sports.