Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury: an exploratory cross-sectional study

Abstract

Objectives: There is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR).

Methods: Twenty-four women and 29 men (mean 26.7 (SD 6.5) years) with ACLR were included. Six POEs (lower extremity and trunk) were scored from a video of five tasks with varying difficulty to compute POE scores (total and subscores). Objective physical function was evaluated with the single-leg hop for distance and side hop. Patient-reported physical function was evaluated using patient-reported outcome measures (PROMs).

Results: Women had significantly more POEs than men (median difference 5.5-25, p≤0.028). More POEs were associated with shorter hop distance and fewer side hops in women (r_s= -0.425 to -0.518, p<0.038), but not in men (r_s<0.301, p>0.05). No associations were found between POE scores and PROMs, in either sex (r_s< -0.246, p>0.05).

Conclusions: Women with ACLR seem to have more POEs compared with men, indicating worse postural orientation. More POEs were associated with worse hop performance, suggesting that POE scores may be used as criteria for rehabilitation progression. The lack of associations between POE scores and PROMs indicate that these measures complement each other.

Keywords: anterior cruciate ligament; gender; knee injuries; questionnaire; sports physiotherapy.

Figure 1

Flow chart over the recruitment process.