Academic journal article Research Quarterly for Exercise and Sport

Distance Reached in the Anteromedial Reach Test as a Function of Learning and Leg Length

Academic journal article Research Quarterly for Exercise and Sport

Distance Reached in the Anteromedial Reach Test as a Function of Learning and Leg Length

Article excerpt

The Anteromedial Reach Test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = .44-.50) between reach distance and leg length, therefore reach distances were normalized for leg length. Normalized reach distance increased significantly over the 15 trials (p <. 01), reaching a plateau after 8 trials, identified by a moving average graph. It is recommended that participants be afforded eight practice trials and that reach distances be normalized by expressing them as a percentage of leg length.

Key words: anterior cruciate ligament, injury, outcome measures, practice


The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee (Miyasaka, Daniel, Stone, & Hirshman, 1991). Following ACL rupture, functional instability (knee giving way or perceived instability with dally or athletic activities involving leg rotation) is a prime concern (Herrington, Hatcher, Hatcher, & McNicholas, 2009). Rehabilitation of these patients, whether as part of a conservative or surgical treatment strategy, therefore focuses on improving neuromuscular function to enable better knee stabilization during dynamic activities (Hewett, Paterno, & Myer, 2002). Rehabilitation progress can be monitored using a number of available patient-reported or performance-based outcome measures (Bent, Wright, Rushton, & Batt, 2009). Patient-reported measures are questionnaires regarding knee symptoms and physical functioning, such as the Lysholm Score (Tegner & Lysholm, 1985), while performance-based measures are tests of physical function (e.g., isokinetic strength, Johnson & Siegel, 1978; and hop testing, Reid, Birmingham, Stratford, Alcock, & Giffin, 2007).

Because the goal of ACL rehabilitation is often to return patients to dynamic, physically demanding, and potentially injurious activities, it has been proposed that performance-based measures are particularly important for evaluating these patients (Reid et al., 2007). However, many of these measures have been criticized for (a) testing a patient's ability to produce force in the sagittal plane, rather than the ability to stabilize the knee during functional, mnltiplanar motions (Colby, Hintermeister, Torry, & Steadman, 1999), (b) showing poor correlation with patient-reported levels of function (Ross, Irrgang, Denegar, McCloy, & Unangst, 2002), or (c) being unavailable in many clinical settings owing to requirements for expensive and sophisticated laboratory equipment (Holm, Hammer, Larsen, Nordsletten, & Steen, 1995). For these reasons, a new ACL-specific, performance-based measure, the Anteromedial Reach Test (ART), was developed (Rice, Hunt, & Batt, 2004).

Inexpensive and easy to administer, the ART requires patients to balance on one leg while reaching as far as possible with the contralateral leg in an anteromedial direction, thus testing their ability to stabilize the stance leg during dynamic lower extremity valgus (DLEV; Hewett, Myer, & Ford, 2006). This posture, in which the knee is abducted, externally rotated, and partially flexed (see Figure 1), is likely to present a stability challenge to ACL-injured patients. Its adoption during athletic maneuvers such as cutting, landing, and deceleration is one of the most common mechanisms of ACL injury (Hewett et al., 2006), and it can also induce functional instability episodes in ACL-eficient patients (Quatman & Hewett, 2009). The ART has therefore been specifically designed to test dynamic knee stability in ACL-injured patients by placing the knee in a potentially unstable position, yet in a slow, controlled, and safe manner.

Although similar to a component of a pre-existing measure, the anteromedial direction of the Star Excursion Balance Test (SEBT; Robinson & Gribble, 2008), the ART is designed to maximize knee involvement. …

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