Neuromuscular Strengthening Exercises Following ACL And Meniscal Repair In A 15 Year Old Female Athlete With Generalized Knee Laxity: A Case Report

Background and Purpose: Adolescent females are 4-6 times more likely to sustain a non-contact anterior cruciate ligament (ACL) injury compared to their male counterparts. Generalized knee laxity decreases dynamic knee stability and further increases injury risk. In patients with a history of bilateral knee hyperextension who have sustained an ACL injury, it’s vital to recover function after surgery, as well as prevent injury in the contralateral knee. A lack of information exists that addresses simultaneous rehabilitation protocols. The purpose of this case report was to investigate the use of a neuromuscular strengthening program in both the ACL injured and un-injured knees in an adolescent female with generalized knee laxity. Case Description: The patient was a 15-year-old female athlete who sustained an ACL and medial meniscus tear in her left knee competing in the long jump for the first time. Initial deficits were found in strength, range of motion, balance, and gait due to surgery. She reported a history of bilateral knee hyperextension. Progressive neuromuscular exercises included squats, single-leg step downs, and dynamic balance using cues for visual, proprioceptive, and postural feedback. Outcomes: Left quadriceps strength progressed from 2-/5 to 4/5 after 9 weeks of therapy. Flexion ROM improved from 100° to 120° and extension was attained. The patient’s Lower Extremity Functional Scale scores improved from 26/80 to 54/80. Hyperextension improvements included ability to control the right knee during all exercises and while walking and running. Discussion: A neuromuscular strengthening protocol that focused on neutralizing hyperextension influences was beneficial in an adolescent female patient post ACL reconstruction. Future studies should investigate the best practices to address underlying generalized knee laxity in adolescent females with ACL injuries