Patients Walking Faster After Anterior Cruciate Ligament Reconstruction Have More Gait Asymmetry

Knobel, Rachel J.; Ito, Naoaki; Arhos, Elanna K; Capin, Jacob J.; Buchanan, Thomas S.; Snyder‐Mackler, Lynn

doi:10.26603/001c.18710

Cited by 6 publications

(5 citation statements)

References 34 publications

(43 reference statements)

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“…Participants were asked to walk across a 10-m walkway over a built-in force plate (Bertec Corporation, Columbus, OH), at self-selected gait speeds (Table 1). Trials recorded at speeds within 5% of their self-selected gait speeds (9,10,13,25,26) were included for analysis. Retroreflective markers were placed on the pelvis, lower extremity joints, and anatomical landmarks, as described in our previous work (27).…”

Section: Methodsmentioning

confidence: 99%

Identifying Gait Pathology after ACL Reconstruction Using Temporal Characteristics of Kinetics and Electromyography

Ito

Capin

Khandha

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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PurposeAsymmetrical gait mechanics after anterior cruciate ligament reconstruction (ACLR) are associated with the development of posttraumatic knee osteoarthritis. Current measures of gait mechanics have focused heavily on peak magnitudes of knee kinematics, kinetics, and joint contact forces but have seldom considered the rate of knee loading, cumulative knee load, or the timing of motor input surrounding peaks. The purpose of this study was to introduce and describe novel metrics of gait using temporal characteristics of kinetics and EMG to identify neuromuscular deficits of the quadriceps in patients after ACLR.MethodsGait mechanics were assessed 6 months (n = 145) and 24 months (n = 116) after ACLR. External knee flexion rate of moment development (RMD) and knee flexion moment impulse (KFMI) leading up to the time of peak knee flexion moment (pKFM), peak RMD between initial contact to pKFM, and cumulative KFMI were calculated. Extensor latencies from the quadriceps, vastus medialis, vastus lateralis, and rectus femoris (time of pKFM – time of peak EMG activity) during the weight acceptance phase of gait were also calculated. Paired-sample t-tests (α = 0.05) were performed between limbs at both time points.ResultsSlower RMD, smaller KFMI, and longer extensor latencies in the involved compared with uninvolved limb were observed across all measures at 6 months (P < 0.005). At 24 months, RMDpeak was slower, and KFMI50ms, KFMI100ms, and KFMItotal were lower in the involved limb (P < 0.003), but no other asymmetries were found.ConclusionsSlower RMD, smaller KFMI, and prolonged extensor latencies may characterize neuromuscular deficits underlying aberrant gait mechanics early after ACLR. RMD, KFMI, and extensor latencies during gait should be considered in the future to quantify asymmetrical movement patterns observed after ACLR and as markers of recovery.

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Section: Methodsmentioning

confidence: 99%

Identifying Gait Pathology after ACL Reconstruction Using Temporal Characteristics of Kinetics and Electromyography

Ito

Capin

Khandha

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

Self Cite

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“…A successful trial was defined as a trial where the participant walked within 5% of their self-selected gait speed with no evidence of targeting or double striking of the force plate. Biomechanics data were collected using an eight-camera system (120 Hz; Vicon, Oxford, UK) and retroreflective markers placed on lower extremity joints and anatomical landmarks (20,21,32,35,38,39). Force plate data were low-pass filtered at 25 Hz, and marker trajectories were low-pass filtered at 6 Hz.…”

Section: Methodsmentioning

confidence: 99%

Bone–Patellar Tendon–Bone Autograft Harvest Prolongs Extensor Latency during Gait 2 yr after ACLR

Ito

Capin

Khandha

et al. 2022

Medicine &Amp; Science in Sports &Amp; Exercise

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PurposeBone–patellar tendon–bone (BPTB) graft harvest for anterior cruciate ligament reconstruction alters patellar tendon properties, which inflict poor quadriceps neuromuscular function. BPTB autografts are associated with higher rates of posttraumatic osteoarthritis, which in turn is associated with pathological gait. The purpose of this study was to investigate the latency between the time of peak quadriceps activity and the peak knee flexion moment during gait, between those with BPTB grafts (n = 23) and other graft types (hamstring autograft or allografts, n = 54), 5 ± 2 months and 2 yr (25 ± 3 months) after anterior cruciate ligament reconstruction. We hypothesized that longer latencies would be observed in the BPTB graft group in the involved limb. We expected latencies to shorten over time.MethodsKnee moments and quadriceps EMG were collected during gait, and vastus medialis, vastus lateralis, rectus femoris (RF), and quadriceps latencies were calculated. Linear mixed-effects models were used to compare latencies between graft types and over the two time points.ResultsThe main effects of graft type were observed for vastus medialis (P = 0.005) and quadriceps (P = 0.033) latencies with the BPTB graft group demonstrating longer latencies. No main effects of graft type were observed for vastus lateralis (P = 0.051) and RF (P = 0.080) latencies. Main effects of time were observed for RF latency (P = 0.022).ConclusionsOur hypothesis that the BPTB graft group would demonstrate longer extensor latency was supported. Contrary to our second hypothesis, however, latency only improved in RF and regardless of graft type, indicating that neuromuscular deficits associated with BPTB grafts may persist 2 yr after surgery. Persistent deficits may be mediated by changes in the patellar tendon’s mechanical properties. Graft-specific rehabilitation may be warranted to address the long-term neuromechanical deficits that are present after BPTB graft harvest.

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“…The fast speed levels of walking were shown to be a challenging issue for patients with knee diseases. 8 , 9 Previous studies have reported that those who walk fast show more kinetic asymmetries after ACLR, 10 , 11 but the 3D kinematics of ACLR patients at different speeds has not been studied. Recently, we used 3D motion capture to discover the asymmetry of fast walking in patients with ACL deficiency, 12 which led us to wonder if this deficit is fully addressed by ACL reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Whether Patients with Anterior Cruciate Ligament Reconstruction Walking at a Fast Speed Show more Kinematic Asymmetries?

Lai,

Chen,

Huang

et al. 2024

Orthopaedic Surgery

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ObjectiveKnee kinematic asymmetries after anterior cruciate ligament reconstruction (ACLR) are correlated with poor clinical outcomes, such as the progression of knee cartilage degenerations or reinjuries. Fast walking in patients with knee conditions may exacerbate knee kinematic asymmetries, but its impact on ACLR patients is uncertain. The aim of this study is to investigate if fast walking induces more knee kinematic asymmetries in unilateral ACLR patients.MethodsThis cross‐sectional study enrolled 55 patients with unilateral ACLR from January 2020 to July 2022. There were 48 males and seven females with an average age of 30.6 ± 6.4 years. Knee kinematic data were collected at three walking speeds: self‐selected, fast (150% normal), and slow (50% normal). A 3D knee kinematic analysis system measured the data, and self‐reported outcomes assessed comfort levels during walking. We used SPM1D for two‐way repeated ANOVA and posthoc paired t‐tests to analyze kinematic differences in groups.ResultsIn fast walking, ACLR knees exhibited more transverse kinematic asymmetries than intact knees, including greater external rotation angle (1.8°, 38%–43%; gait cycle [GC], p < 0.05 & 1.8–2.7°, 50%–61% GC, p < 0.05) and increased proximal tibial translation (2.1–2.5 mm, 2%–6% GC, p < 0.05 & 2.5–3.2 mm, 92%–96% GC, p < 0.05). Additionally, ACLR knees showed greater posterior tibial translation than intact knees (3.6–3.7 mm, 7%–8% GC, p < 0.05) during fast walking. No posterior tibial translation asymmetries were observed in slow walking compared to normal walking levels. ACLR knees have the most comfortable feelings in slow walking speed, and the most uncomfortable feelings in fast walking speed levels (29%).ConclusionsFast walking induces additional external tibial rotation and proximal and posterior tibial translation asymmetries in ACLR patients. This raises concerns about long‐term safety and health during fast walking. Fast walking, not self‐selected speed, is beneficial for identifying postoperative gait asymmetries in ACLR patients.

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Patients Walking Faster After Anterior Cruciate Ligament Reconstruction Have More Gait Asymmetry

Cited by 6 publications

References 34 publications

Identifying Gait Pathology after ACL Reconstruction Using Temporal Characteristics of Kinetics and Electromyography

Identifying Gait Pathology after ACL Reconstruction Using Temporal Characteristics of Kinetics and Electromyography

Bone–Patellar Tendon–Bone Autograft Harvest Prolongs Extensor Latency during Gait 2 yr after ACLR

Whether Patients with Anterior Cruciate Ligament Reconstruction Walking at a Fast Speed Show more Kinematic Asymmetries?

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