Comparative Effects of Dynamic Stability Drills and Plyometric Training After Anterior Crutiate Ligament Reconstruction

Comparative Effects of Dynamic Stability Drills and Plyometric Training on Terminal Extension Lag After Anterior Cruciate Ligament Reconstruction

Terminal Extension lag (TEL) is a condition that develops when active range of extension is smaller than passive range; frequently noticed in post-traumatic knees after injuries and Anterior Cruciate ligament reconstruction surgery. TEL is typically seen within 6 to 12 weeks after ACL reconstruction. Anterior cruciate ligament reconstruction surgery is a critical surgical intervention used to repair ACL tear; which is common among those who are engaged in physical demanding activities and Sportsmen. In the initial days following surgery terminal extension lag affects up to 10 to 35% of individuals. ACL is expectational because it's not just a static stabilizer of knee but also transfers proprioceptive information to the brain so to improve joint's dynamics. This study aims to compare effects of Dynamic Stability Drills (DSD) and Plyometric Training (PT) in reducing terminal knee extension lag in post-ACL reconstruction patients. This study will be a Randomized Clinical Trail and will be conducted in Physiotherapy Department of Bethania Hospital Sialkot. Non-Probability Convenience Sampling will be used to collect data. Total of 48 Participants of the age 20 to 40 years with terminal extension lag of moderate lag stage (typically 9-12 weeks post-op with 5-10° lag) will be selected as sample size. An informed consent will be taken prior study from all the subjects. Outcomes measure will be included Numerical Pain Rating Scale (NPRS) for pain, Single Leg Hope Test and Y Balance Test (Y-BAL) for Dynamic Stability, Universal Goniometer (UG) for Range of Motion, Sphygmomanometer for Knee Strength, International Knee Documentation Committee scores, (IKDC) for Knee function and Limb Symmetry Index (LSI) Calculations. Subjects will be divided into two groups by random number generator table. Both groups will receive a standard physiotherapy protocols which will include: Hot pack , TENS , Mobilizations, Stretching and Strengthening. Group A will receive Dynamic Stability Drills and Group B will receive Plyometric Training along with conventional treatment. Patient will come 3 time a week and data will be recollected after 6 weeks. Data will be analyzed by SPSS version 25.

Study Overview

• Status: Recruiting
• Conditions: Sports Physical Therapy
• Intervention / Treatment: Other: Dynamic Stability Drills; Other: Plyometric Training

• Study Type: Interventional
• Enrollment (Estimated): 48
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rabiya Noor, PhD; Phone Number: 0334 4355660; Email: rabiya.noor@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Rabiya Noor
      • Contact: iqbal Tariq, phd; Phone Number: 03338236752; Email: iqbal.tariq@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 20-40
• Both Genders (male & female)
• History of Anterior Cruciate Ligament Reconstruction (ACLR) between 1-3 years
• Moderate stage (5 to 10 ˚) of terminal extension lag after ACL reconstruction

Exclusion Criteria:

• Any other previously serious knee pain and/or surgery limiting of knee range of motion(2)
• Any traumatic conditions around the knee, or any infectious or tumors conditions i.e.

meniscus injury, fracture, dislocation or osteochondral injury

• Pregnancy, any recently underwent abdominal and back surgery
• BMI ≥ 30 kg/m²
• Any systemic and/or neurological illness, rheumatoid arthritis, osteomyelitis, any neurological disorders, spinal disorders, obesity, Dementia, inflammatory conditions like Ankylosing spondylitis, Rheumatoid arthritis, Osteoporosis, Diabetic neuropathy,
• Red flags such as Trauma, Cancer, Constitutional Symptoms (Fever, Malaise, Weight Loss), Recent Infection, Mental retardation, Hemiparesis / Hemiplegia
• Subjects with presence of any fractures
• Heart/diabetic patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Plyometric Training	Other: Plyometric Training; Weak 1-2: Four types of plyometrics: A) bilateral off-set (alternating box jump) B) bilateral asymmetrical (split jump) C) bilateral symmetrical (30 cm drop jump) and D) unilateral (30 cm drop jump(13) Weak 3-4: A lateral jump from left to right limb (A) with landing (B) and immediate jump back to the right limb (C) as opposed to just landing in which occurs during Stage 2(13).; Images of a countermovement or squat jump in place with maximal height. The removal of the box results in higher landing forces due to landing from a higher height(13
Experimental: Dynamic Stability Drills	Other: Dynamic Stability Drills; Weak 1-2 Stability Foundation Weight shifts (anterior/posterior, lateral, Double-leg stance on foam surface, Eyes-closed balance (double-leg), Isometric quad & hamstring contractions, Wall sits + small ball between knees (activate adductors & quads)Weeks 3-4: Progressive Dynamic Stability, Single-leg stance on foam, Thera-band perturbation drills (knees and hips), TKE (Terminal Knee Extension) on unstable surfaces, Step-downs from 6-inch height (with control),Lateral step-overs (slow & controlled)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Single leg hope test	Jumping as far as you can on one leg while maintaining your balance and landing firmly is the goal of this challenge. The starting line and the landing leg's heel are used to estimate the distance	6th week
Limb Symmetry Index (LSI) Calculation	the Limb Symmetry Index (LSI) calculates the performance difference between two limbs, typically the affected and unaffected limbs following an accident; by dividing the score of the injured limb by the score of the unaffected limb and multiplying the result by 100. It's represented in percentage	6th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Rabiya Noor, PhD, Riphah International University

Publications and helpful links

General Publications

• Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997 Jan-Feb;25(1):130-7. doi: 10.1177/036354659702500126.

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2026
• Primary Completion (Estimated): May 15, 2026
• Study Completion (Estimated): June 15, 2026

Study Registration Dates

• First Submitted: May 5, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 11, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Plyometric Exercise; Terminal Extension Lag
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Therapeutics; Physical Therapy Modalities; Patient Care; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Physical Conditioning, Human; Exercise; Plyometric Exercise
• Other Study ID Numbers: REC/RCR&AHS/25/0148

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No