Longitudinal Changes in the Total Knee Joint Moment After Anterior Cruciate Ligament Reconstruction Correlate With Cartilage Thickness Changes

Abstract

This study investigated associations between changes in the total joint moment (TJM) at the knee and changes in cartilage thickness after anterior cruciate ligament reconstruction (ACLR). Seventeen subjects (five males; age: 29.6 ± 7.3 years) with unilateral ACLR underwent gait analysis and magnetic resonance imaging at baseline (2.2 ± 0.3 years post-ACLR) and at long-term follow-up (7.7 ± 0.7 years post-ACLR). Knee loading was assessed using the TJM, and differences in loading were analyzed using repeated measures analysis of variance. Pearson correlation coefficients assessed associations between changes in TJM and changes in (medial-tolateral) M/L femoral cartilage thickness ratios in the ACLR limb. Bilaterally, there was no significant change in the magnitude of the TJM first peak (TJM1), however, there was a significant increase in the percent contribution of the knee flexion moment (KFM) (p < 0.001) and decrease in the percent contribution of the knee adduction moment (KAM) to TJM1 (p < 0.001). The change in the percent contributions of KFM and KAM to TJM1 were associated with changes in M/L femoral cartilage thickness in the ACLR limb. Specifically, subjects with smaller increases in KFM contribution (R = 0.521, p = 0.032) and smaller decreases in KAM contribution (R = −0.521, p = 0.032) had a reduction in the M/L ratio in the central femoral subregion over the follow-up period, with similar trends in the external femoral subregion. The study results provide new insight into changes in the loading environment at the knee joint prospectively following ACL reconstruction and give evidence that there are modifiable gait metrics that are associated with cartilage changes after ACLR.

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury

“…48 As such, patients with an ACL injury and meniscal involvement are highly representative of the patient population, particularly those at greatest risk of PTOA. The literature suggests that changes in gait biomechanics are also present in the uninjured contralateral limb following ACLR, 7 However, KOOS pain scores were highly similar across our groups, and the literature indicates that KOOS pain scores are highly reliable over similar time periods, 50 thus it is unlikely that changes in pain influenced our results.…”

“…5,40 However, greater KAM is associated with morphological and compositional changes in tibiofemoral cartilage following ACLR. 7,41 Our results suggest that vibration may be an effective approach for reducing loading of the medial tibiofemoral compartment in which PTOA is more common following ACLR, 42 but additional research is necessary to elucidate any effects on joint health outcomes.…”

Kinetic Asymmetry During a Repetitive Tuck Jump Task in Athletes with a History of Anterior Cruciate Ligament Reconstruction

“…increased knee extension moments) for their uninvolved limb during bilateral landing and jumping. 6,10,11 These persistent kinetic asymmetries may increase risk of a secondary ACL injury 24 and/or contribute to knee degenerative changes. 11,25,26 As a result, there appears to be a need to explore novel rehabilitation approaches that could potentially more effectively target these persistent kinetic asymmetries.…”

Effect of Sex and Ankle Brace Design on Knee Biomechanics During a Single-Leg Cut

“…Rather, participants exhibited a significant 2.2% increase in TKM sag during the single-leg cut when wearing the ARG. Increased TKM sag has been associated with greater quadriceps activation during sports-relevant tasks, 2,17 which may in turn increase muscle-induced anterior shear at the knee joint 35 and subsequent ACL strain. 46 Moreover, prophylactic design had a significant effect on TKM front , although the 0.7%-1.6% decrease in TKM front exhibited with the ankle prophylactics (ARG, brace, and tape) as compared with control did not reach statistical significance with pairwise testing.…”

“…22 Despite reported increases in deleterious knee biomechanics with an ankle prophylactic, it is unknown if prophylactic use also leads to concomitant increase in knee joint loads. Total knee reaction moment represents the external load placed on the joint, and it increases after musculoskeletal injury 17 and disease 2,9 and may increase with ankle prophylactic use.…”