Immediate Biochemical Changes After Gait Biofeedback in Individuals With Anterior Cruciate Ligament Reconstruction

Abstract

Context Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage metabolism. Objective To determine if acutely manipulating peak vertical ground reaction force (vGRF) during gait influences acute changes in serum cartilage oligomeric matrix protein concentration (sCOMP) among individuals with ACLR. Design Crossover study. Patients or Other Participants Thirty individuals with unilateral ACLR participated (70% female, age = 20.43 ± 2.91 years old, body mass index = 24.42 ± 4.25, months post-ACLR = 47.83 ± 26.97). Additionally, we identified a subgroup of participants who demonstrated an increase in sCOMP after the control or natural loading condition (sCOMPCHANGE > 0 ng/mL, n = 22, 70% female, age = 20.32 ± 3.00 years old, body mass index = 24.73 ± 4.33, months post-ACLR = 47.27 ± 29.32). Main Outcome Measure(s) Serum was collected before and immediately after each condition to determine sCOMPCHANGE. Intervention(s) All participants attended 4 sessions that involved 20 minutes of walking on a force-measuring treadmill consisting of a control condition (natural loading) followed by random ordering of 3 loading conditions with real-time biofeedback: (1) symmetric vGRF between limbs, (2) a 5% increase in vGRF (high loading), and (3) a 5% decrease in vGRF (low loading),. A general linear mixed model was used to determine differences in sCOMPCHANGE between altered loading conditions and the control group in the entire cohort and the subgroup. Results The sCOMPCHANGE was not different across loading conditions for the entire cohort (F3,29 = 1.34, P = .282). Within the subgroup, sCOMPCHANGE was less during high loading (1.95 ± 24.22 ng/mL, t21 = −3.53, P = .005) and symmetric loading (9.93 ± 21.45 ng/mL, t21 = −2.86, P = .025) compared with the control condition (25.79 ± 21.40 ng/mL). Conclusions Increasing peak vGRF during gait decreased sCOMP in individuals with ACLR who naturally demonstrated an increase in sCOMP after 20 minutes of walking. Trial Registry ClinicalTrials.gov (NCT03035994)

Linking Gait Biomechanics and Daily Steps After ACL Reconstruction

“…These findings are not surprising because previous work has demonstrated that the uninjured limb may develop altered gait patterns that are similar to the ACLR limb (11). These data suggest that multiple loading parameters (daily steps and biomechanics) are simultaneously affected in some individuals after ACL injury and ACLR (2,15,16). Our study indicates that future efforts should be made to measure both gait biomechanics and loading frequency after ACLR to best understand the cumulative loading changes in specific patients.…”

Sensory substitution for orthopaedic gait rehabilitation: A systematic review and meta-analysis for clinical practice guideline development

“…Most articles excluded at this stage included inappropriate outcome measures. 11 studies were judged to satisfy inclusion criteria and were included for analysis and synthesis [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. References of these articles were reviewed to identify any further relevant studies.…”

Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction

“…Low . biomechanical gait patterns more similar to uninjured controls and decreases serum biomarker concentrations of cartilage turnover (22,35,36). In contrast, individuals with ACLR-T1ρ Low profiles who decrease KAM between 6 and 12 months post-ACLR start with higher KAM values than the uninjured controls, and the trend to decrease KAM between 6 and 12 months post-ACLR in the ACLR-T1ρ Low group may be an attempt to express loading profiles similar to uninjured controls.…”

“…Furthermore, we speculate that individuals with the most deleterious changes in cartilage composition who demonstrate lower KAM profiles than uninjured controls 6 months after ACLR may benefit from interventions seeking to increase KAM magnitudes to values that match uninjured controls. A single session of gait retraining in individuals with an ACLR that cues an increase in peak vertical ground reaction force results in biomechanical gait patterns more similar to uninjured controls and decreases serum biomarker concentrations of cartilage turnover (22,35,36). In contrast, individuals with ACLR-T1ρ Low profiles who decrease KAM between 6 and 12 months post-ACLR start with higher KAM values than the uninjured controls, and the trend to decrease KAM between 6 and 12 months post-ACLR in the ACLR-T1ρ Low group may be an attempt to express loading profiles similar to uninjured controls.…”