Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis

Kaur, Mandeep; Ribeiro, Daniel Cury; Theis, Jean‐Claude; Webster, Kate E.; Sole, Gisela

doi:10.1007/s40279-016-0510-4

Cited by 115 publications

(108 citation statements)

References 89 publications

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“…The ACLR and contralateral limbs changed similarly over the follow-up period, suggesting a bilateral adaptation to injury of a single limb. While it is well-documented that there are alterations in gait mechanics following ACLR, there exists some conflicting evidence on the direction and magnitude of such changes 6; 7 . These discrepancies may partially be due to the time at which the studies were conducted after reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…This change could be considered an improvement, as no difference was observed at 8-year follow-up in peak KFM as compared to the healthy control population, while a reduction in peak KFM was observed in both the ACLR and contralateral limbs at baseline versus control. Previous work has shown that ACLR subjects display reduced peak KFM 6 , an indication of diminished quadriceps function 48 , possibly due to reduced quadriceps strength, impaired neuromuscular control, compensatory movements, or lingering symptoms. Thus, the increase in KFM over time may indicate long-term continued recovery of quadriceps function.…”

Section: Discussionmentioning

confidence: 99%

“…Further, nearly 70% show cartilage degeneration on MRI less than 3 years after ACLR 5 . A proposed mechanism for increased risk of development of knee OA after ACL injury and reconstruction is the evidence of abnormal knee biomechanics beginning early after ACLR as summarized in several recent systematic reviews 6; 7 . Data demonstrates that cartilage becomes conditioned to a typical loading environment 8 .…”

Section: Introductionmentioning

confidence: 99%

“…While kinematic 7; 15; 16 and kinetic 6; 7; 17 changes to the ACLR knee have been described in all three planes of motion, the majority of studies have investigated joint biomechanics at a single time point following ACLR. Measurements at a single time point may not capture longer-term outcome of ACLR surgery, including changes that could occur in joint loading over time.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction

Erhart‐Hledik

Chu

Asay

et al. 2017

Journal Orthopaedic Research

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The purpose of this study was to longitudinally investigate changes in knee joint kinematics and kinetics from 2 to 8 years post-ACLR. Seventeen subjects with primary unilateral transtibial ACLR performed bilateral gait analysis approximately 2 years and 8 years post-ACLR. Seventeen matched healthy control subjects were also analyzed. Kinematic and kinetic comparisons between the ACLR and contralateral limbs over time were completed using a 2 × 2 (time, limb) repeated-measures ANOVA. Unpaired Student's t-tests were used to compare the ACLR and contralateral kinematics and kinetics to the control group. The ACLR and contralateral limbs had similar gait changes over time. Kinetic changes over time included a reduction in first (p = 0.048) and second (p < 0.001) peak extension moments, internal rotation moment (p < 0.001), adduction moment (first peak: p = 0.002, second peak: p = 0.009, impulse: p = 0.004) and an increase in peak knee flexion moment (p = 0.002). Kinematic changes over time included increases in peak knee flexion angle in the first half of stance (p = 0.026), minimum knee flexion angle in the second half of stance (p < 0.001), and average external rotation angle during stance (p = 0.007), and a reduction in average anterior femoral displacement during stance (p = 0.006). Comparison to healthy controls demonstrated improvement in some gait metrics over time. The results demonstrated longitudinal changes from 2 to 8 years after ACLR in knee joint kinetics and kinematics that have been related to clinical outcome after ACLR and the progression of knee OA, and support future larger and comprehensive investigations into long-term changes in joint mechanics in the ACLR population. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1478-1486, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction

Erhart‐Hledik

Chu

Asay

et al. 2017

Journal Orthopaedic Research

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“…Following ACLR, patients walk with smaller knee flexion–extension excursion and peak flexion, while also demonstrating lower knee flexion moments, in the involved compared with contralateral knee . These altered mechanics likely influence the direction and magnitude of the forces exerted on the patellofemoral cartilage during walking.…”

mentioning

confidence: 99%

Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction

Capin

Williams

Neal

et al. 2019

Journal Orthopaedic Research

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Post‐traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty‐six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: −0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: −0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645–652, 2020

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Sustained Limb‐Level Loading: A Ground Reaction Force Phenotype Common to Individuals at High Risk for and Those With Knee Osteoarthritis

Bjornsen,

Berkoff,

Blackburn

et al. 2024

Arthritis & Rheumatology

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OBJECTIVETo compare the vertical (vGRF), anterior‐posterior (apGRF) and medial‐lateral (mlGRF) ground reaction force (GRF) profiles throughout the stance phase of gait: 1) between individuals 6‐12 months post anterior cruciate ligament reconstruction (ACLR) and uninjured matched controls; and 2) between ACLR and individuals with differing radiographic severities of knee osteoarthritis (KOA) defined as Kellgren and Lawrence (KL) grades KL2, KL3, and KL4.METHODA total of 196 participants were included in this retrospective cross‐sectional analysis. Gait biomechanics were collected from individuals 6‐12 months post‐ACLR (n=36), uninjured controls matched to the ACLR group (n=36), and individuals with KL2 (n=31), KL3 (n=67), and KL4 OA (n=26). Between‐group differences in vGRF, apGRF, and mlGRF were assessed in reference to the ACLR group throughout each % of stance phase using a functional linear model.RESULTSThe ACLR group demonstrated lesser vGRF and apGRF in early and late stance compared to the uninjured controls, with large effects (d range: 1.35‐1.66). Conversely, the ACLR group exhibited greater vGRF (87‐90%; 4.88%BW; d=0.75) and apGRF (84‐94%; 2.41%BW; d=0.79) than the KL2 group in a small portion of late stance. No differences in mlGRF profiles were observed between the ACLR and either the uninjured controls or the KL2 group. The magnitude of difference in GRF profiles between the ACLR and OA groups increased with OA disease severity.CONCLUSIONIndividuals 6‐12 months post‐ACLR exhibit strikingly similar GRF profiles as individuals with KL2 KOA, suggesting both patient groups may benefit from targeted interventions to address aberrant GRF profiles.image

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Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-Analysis

Cited by 115 publications

References 89 publications

Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction

Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction

Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction

Sustained Limb‐Level Loading: A Ground Reaction Force Phenotype Common to Individuals at High Risk for and Those With Knee Osteoarthritis

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