Long-Term Gait Deviations in Anterior Cruciate Ligament–Reconstructed Females

Abstract

Purpose Little is known of the potential long term gait alterations that occur after an anterior cruciate ligament (ACL) reconstruction. In particular, variables such as impact loading which have been previously associated with joint deterioration have not been studied in walking and running after an ACL reconstruction. The purpose of this study was to define the alterations in impact forces, loading rates, and the accompanying sagittal plane kinematic and kinetic mechanics at the time of impact between the ACL reconstructed group and a healthy control group. Methods 40 females (20 ACL reconstruction, 20 controls) participated in the study. An instrumented gait analysis was performed on all subjects. Between group and limb comparisons were made for initial vertical impact force, loading rate, sagittal plane knee and hip angles as well as moments. Results During walking and running the ACL cohort had significantly greater initial vertical impact force (p=0.002 and p= 0.001), and loading rates (p=0.03 and p= 0.01), as well as a smaller knee extensor moment and hip angle during walking (p=0.000 and p=0.01). There was a trend towards a smaller knee moment and hip angle during running (p=0.08 and p=0.06) as well as a larger hip extensor moment during walking (p=0.06) in the ACL group. No differences were found for hip extensor moment during running, knee angles between groups during walking or running. Lastly, no between limb differences were found for any variable. Conclusion Gait deviations such as elevated impact loading and loading rates do not resolve long term after the individual has resumed previous activity levels and may contribute to the greater risk of early joint degeneration in this population.

Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

“…Very limited evidence of smaller peak knee flexion angles in individuals with ACLR was provided by one moderate-quality study at 1–3 years postsurgery (−2.21, −3.16 to −1.26),19 and one low-quality study at ≥3 years postsurgery, (−1.38, −2.14 to −0.62) 20. Two studies reported mean knee flexion angle in individuals who were 6 months post-ACLR,21 22 and a single study reported peak angle at initial impact in individuals ≥3 years post-ACLR 23. These studies were not included in meta-analyses.…”

Clinical Strategies for Addressing Muscle Weakness Following Knee Injury

“…4 Altered gait biomechanics are common in patients with persistent muscle weakness following acute joint injury. [5][6][7] ACL-injured or ACL-R patients demonstrate more extended or stiffened knee joint angles during walking gait, 6,8,9 potentially due to the inability to adequately eccentrically activate the quadriceps during the stance phase of gait. 10 A more extended knee at initial foot contact and during midstance of gait may alter proper energy attenuation, leading to a high rate of impulsive loading, which is known to damage cartilage cells.…”

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

“…Peak knee flexion angle, 140,200,201 knee adduction angle, 37,154 and knee internal rotation angle 154,198 are decreased in ACLR compared to both contralateral and healthy control limbs up to 48 months after surgery. Peak external knee extension moment, 205 knee adduction moment 176,205 and knee external rotation moment 176,205 remain reduced in ACLR compared to healthy control limbs up to 36 months after surgery.…”

“…6,9,37,201 The continuation of tri-planar alterations in walking gait over a 3 year period following ACLR, which may account for as many as 4 million steps for the average American, 18 may have significant impact on long term joint health at long term follow-up. There are few studies that have followed up with patients greater than 36 months post-ACLR, 37,140 making it difficult to fully appreciate the progression of walking kinematics and kinetics after ACLR.…”

“…104,140 These deviations in run gait after ACLR may be directly related to decreased knee extensor strength. Vastus lateralis activation increases in healthy limbs during high-intensity running, defined as 40% above lactate threshold, while vastus lateralis activation remained unchanged in the ACLR limb.…”