Background Patients with knee injury appear to have worse postural orientation (i.e., alignment between body segments), at the knee, measured with gold standard three-dimensional motion analysis, compared with controls. However, there is a lack of studies on postural orientation for other joints than the knee, e.g., hip and trunk, as well as with a clinically applicable method.

Objective To investigate whether visual assessment of Postural Orientation Errors (POEs) differs between patients with anterior cruciate ligament reconstruction (ACLR) and healthy controls.

Design Cross-sectional study

Setting Clinical setting

Participants Inclusion criteria were: age 18–39 years, >16 weeks post-ACLR, and initiated jumping exercises. Fifty-three patients with ACLR (45% women), mean age 26.7 (SD 6.5) years, and 30 controls (50% women), mean age 28 (SD 7.9) years, were included.

Interventions Six POEs of the lower extremity and trunk, e.g., knee medial-to-foot position and femoral valgus, were visually assessed as good, fair, or poor, from video-recordings of 5 functional tasks. A score from 0 (good) to 100 (poor) was calculated for two subscales; activities of daily living (ADL) (single-leg squat, stair descending, forward lunge) and Sport (single-leg hop, side-hop), and a Total POE score (all 5 tasks). The injured leg was assessed in patients, and the right leg in controls.

Main Outcome Measurements POE scores

Results Patients with ACLR had significantly worse POE scores compared with controls, POE subscale ADL (ACLR: median 18.5 (quartiles 11–26), controls: 11 (3.7–14.8), p=0.0001), POE subscale Sport (ACLR: 26 (16.7–29.6), controls: 7.4 (3.7–15.7), p=0.0001), and Total POE score (ACLR: 23.2 (14.3–25.9), controls: 8 (5.4–16), p=0.0001).

Conclusions Patients with ACLR appear to have worse postural orientation, measured with visual assessment, compared with controls. Visual assessment of POEs could be used to guide injury treatment aimed at improving postural orientation before return to sport, and potentially also to guide prevention training.