The effect of exercise rehabilitation on bone mineral density, muscle strength, and physical function outcomes in ACL ruptures: A randomized controlled clinical trial

Abstract

The purpose is to explore the effects of Exercise rehabilitation (ER) on bone mineral density (BMD) of the knee, muscle strength (MS), and physical function (PF) after ACL rupture. Finally, A total of 58 patients were randomized into 2 groups (Control Group [CON]: conventional treatment, male =16, female =13, age =[31.63 ±8.01] years; Exercise rehabilitation group [ER]: 6-week ER on CON basis, male =17, female =12, age =[31.26 ±7.07] years). At baseline and 6 weeks, the knee BMD was measured using DEXA, MS and PF measures were recorded by isokinetic strength test, IKDC, Lysholm, and VAS score. T-tests, analysis of variance (ANOVA), and Mann-Whitney tests were used for comparisons. The BMD outcomes: after a 6-week period, the BMD of the CON ([1.47 ±0.24] g ·cm^-2) was significantly lower than that of the ER ([1.65 ±0.37] g ·cm^-2) at lateral condyle of femur (LCF) (p =0.041). MS outcomes: at 6 weeks, the relative peak torque (RPT) of the quadriceps and hamstrings during concentric contractions in ER group were significantly higher than that in CON group (p <0.001, p =0.017). Similarly, during eccentric contractions in ER group, the RPT of the quadriceps and the H/Q ratio revealed significant variations from the CON group (p =0.033, p =0.043). PF outcomes: the IKDC, Lysholm, and VAS scores of the ER group were significantly improved compared to the CON group (p <0.001, p <0.001, p =0.002). The conclusion is that 6 weeks of ER intervention for patients with ACL rupture can effectively delay the decline of BMD in the LCF of the knee joint, and enhance the restoration of MS and PF. This provides guidance for clinical rehabilitation.

Keywords

Anterior cruciate ligament / Rehabilitation / Bone mineral density / Joint function

CRediT authorship contribution statement

Yue Wu: Writing original draft. Ruilan Dai: Data curation. Yunan Zhou: Formal analysis. Wenqiang Yan: Data curation. Shuang Ren: Methodology. Xi Gong: Data curation, Conceptualization. Yingfang Ao: Data curation, Conceptualization.

Registrations

This study was registered at www.clinicaltrials.gov (NCT05924178).

Ethical approval statement

All participants have provided their written informed consent. The study has been reviewed and approved by the Ethics Committee of Peking University Third Hospital, with the assigned approval number 202303303. This study adheres to the ethical guidelines outlined in the Helsinki Declaration for human research.

Funding

Funding for this study was provided by the Joint Fund for Regional Innovation and Development (U23A20471), Beijing Natural Science Foundation (L242161, L241073, and 7232354).

Declaration of competing interest

Yingfang Ao is an Editorial Board Member for Sports Medicine and Health Science and was not involved in the editorial review or the de-cision to publish this article. All authors have agreed to publish the present article and declare no conflict of interest.

Acknowledgments

The authors extend their heartfelt thanks to the participants for their invaluable contributions to this study.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.smhs.2025.03.002.

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