The Effects of Eccentric and Plyometric Training Programs and Their Combination on Stability and the Functional Performance in the Post-ACL-Surgical Rehabilitation Period of Elite Female Athletes

Sofien Kasmi; Hassane Zouhal; Raouf Hammami; Cain C T Clark; Anthony C Hackney; Amri Hammami; Mokhtar Chtara; Sabri Gaied Chortane; Fatma Zohra Ben Salah; Urs Granacher; Omar Ben Ounis

doi:10.3389/fphys.2021.688385

The Effects of Eccentric and Plyometric Training Programs and Their Combination on Stability and the Functional Performance in the Post-ACL-Surgical Rehabilitation Period of Elite Female Athletes

Front Physiol. 2021 Jul 2:12:688385. doi: 10.3389/fphys.2021.688385. eCollection 2021.

Authors

Sofien Kasmi^{1

2}, Hassane Zouhal³, Raouf Hammami^{4

5}, Cain C T Clark⁶, Anthony C Hackney⁷, Amri Hammami⁸, Mokhtar Chtara¹, Sabri Gaied Chortane⁴, Fatma Zohra Ben Salah⁹, Urs Granacher¹⁰, Omar Ben Ounis^{1

4}

Affiliations

¹ Tunisian Research Laboratory "Sport Performance Optimization", National Center of Medicine and Science in Sports, Tunis, Tunisia.
² Department of Physiotherapy, Posturology and Functional Rehabilitation, National Center of Medicine and Science in Sports, Tunis, Tunisia.
³ M2S Laboratory (Movement Sport Science Laboratory), Université Rennes, Rennes, France.
⁴ Higher Institute of Sport and Physical Education of Ksar Saïd, Tunis, Tunisia.
⁵ Research Laboratory: Education, Motor Skills, Sports and Health (EM2S, UR15JS01), Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
⁶ Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.
⁷ Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁸ Laboratory of Physiology, Ibn El Jazzar Medical Faculty of Sousse, Sousse, Tunisia.
⁹ Department of Physical Medicine and Rehabilitation, Institute of Orthopedics "M.T. Kassab," Manouba, Tunisia.
¹⁰ Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany.

Abstract

Background: The standard method to treat physically active patients with anterior cruciate ligament (ACL) rupture is ligament reconstruction surgery. The rehabilitation training program is very important to improve functional performance in recreational athletes following ACL reconstruction.

Objectives: The aims of this study were to compare the effects of three different training programs, eccentric training (ECC), plyometric training (PLYO), or combined eccentric and plyometric training (COMB), on dynamic balance (Y-BAL), the Lysholm Knee Scale (LKS), the return to sport index (RSI), and the leg symmetry index (LSI) for the single leg hop test for distance in elite female athletes after ACL surgery.

Materials and methods: Fourteen weeks after rehabilitation from surgery, 40 elite female athletes (20.3 ± 3.2 years), who had undergone an ACL reconstruction, participated in a short-term (6 weeks; two times a week) training study. All participants received the same rehabilitation protocol prior to the training study. Athletes were randomly assigned to three experimental groups, ECC (n = 10), PLYO (n = 10), and COMB (n = 10), and to a control group (CON: n = 10). Testing was conducted before and after the 6-week training programs and included the Y-BAL, LKS, and RSI. LSI was assessed after the 6-week training programs only.

Results: Adherence rate was 100% across all groups and no training or test-related injuries were reported. No significant between-group baseline differences (pre-6-week training) were observed for any of the parameters. Significant group-by-time interactions were found for Y-BAL (p < 0.001, ES = 1.73), LKS (p < 0.001, ES = 0.76), and RSI (p < 0.001, ES = 1.39). Contrast analysis demonstrated that COMB yielded significantly greater improvements in Y-BAL, LKS, and RSI (all p < 0.001), in addition to significantly better performances in LSI (all p < 0.001), than CON, PLYO, and ECC, respectively.

Conclusion: In conclusion, combined (eccentric/plyometric) training seems to represent the most effective training method as it exerts positive effects on both stability and functional performance in the post-ACL-surgical rehabilitation period of elite female athletes.

Keywords: anterior cruciate ligament; eccentric-plyometric; functional performance; return-to-sport; stability; training.