Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis

Slater, Lindsay V.; Hart, Joseph M.; Kelly, Adam; Kuenze, Christopher

doi:10.4085/1062-6050.52.6.06

Cited by 7 publications

(9 citation statements)

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“…Both reconstructed and contralateral limbs of the PCL group exhibited important kinematic and kinetic deviations at the knee compared with the CON group; these differences occurred mainly in the sagittal plane. Deviations from healthy controls in sagittal-plane angles and moments have been noted previously in knees that have undergone ACL or multiple ligament reconstruction, 23,43 with the variability likely reflective of the affected joint structures. In the current study, both reconstructed and contralateral limbs of the PCL group exhibited larger knee flexion angles during initial contact, early stance, and late stance compared with the CON group.…”

Section: Discussionmentioning

confidence: 61%

“…These results are in agreement with evidence showing that patients who undergo surgical treatment for unilateral musculoskeletal knee conditions (eg, ACL reconstruction, total knee arthroplasty) tend to re-establish a relatively symmetrical gait over time. 5,6,43,55 Whether symmetrical gait represents a successful outcome remains unclear. Restored symmetry may reflect improved symptoms and functional recovery after cruciate ligament reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with reconstructed cruciate ligaments can exhibit altered movement patterns at the hip and ankle, 12,38,43 and discrepancies can arise in the frontal and transverse planes. 17,32,43 Second, reconstructed limbs were compared with uninjured contralateral limbs or limbs from unmatched controls; uninjured contralateral limbs of patients who underwent PCL reconstruction have not been compared with limbs from matched controls. While asymmetries can appear in the early stages after knee surgery, symmetrical gait is typically restored after several years.…”

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confidence: 99%

“…While asymmetries can appear in the early stages after knee surgery, symmetrical gait is typically restored after several years. 5,6,11,43,55 Yet, a comparison of the reconstructed and contralateral limbs of patients who underwent PCL reconstruction-to each other and to sex-and age-matched controls-is required for a systematic and robust evaluation of potential gait asymmetries in longitudinal studies. Lastly, previous work had follow-up times of \3.5 years after surgery.…”

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confidence: 99%

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Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries

et al. 2021

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Background: It remains unclear how posterior cruciate ligament (PCL) reconstruction influences long-term lower extremity joint biomechanics. Purpose: To determine whether patients who underwent PCL reconstruction exhibited long-term alterations in lower limb gait mechanics. Study Design: Controlled laboratory study. Methods: A total of 26 patients underwent gait analyses at 8.2 ± 2.6 years after primary unilateral PCL reconstruction. Sex- and age-matched healthy controls were analyzed for comparison. Gait data were collected using motion capture and force plates. Hip, knee, and ankle angles and moments were compared during initial contact, early stance, and late stance for the reconstructed and uninjured contralateral limbs of patients who underwent PCL reconstruction (PCL group) as well as the limbs of healthy control participants (CON group). Results: No side-to-side kinematic differences were noted between the reconstructed and contralateral limbs of the PCL group; some trivial differences were noted in knee and hip moments. However, major differences between the PCL and CON groups occurred at the knee. Reconstructed and contralateral limbs of the PCL group exhibited larger knee flexion angles during initial contact (Δ = 7.0° [ P < .001] and Δ = 6.9° [ P < .001], respectively), early stance (Δ = 5.8° [ P = .003] and Δ = 6.7° [ P < .001], respectively), and late stance (Δ = 7.9° [ P < .001] and Δ = 8.0° [ P < .001], respectively) compared with the CON group. During early stance, contralateral limbs of the PCL group displayed larger knee flexion moments (Δ = 0.20 N·m/kg; P = .014) compared with the CON group, and both reconstructed (Δ = 0.05 N·m/kg; P = .027) and contralateral (Δ = 0.07 N·m/kg; P = .001) limbs of the PCL group exhibited larger knee external rotation moments compared with the CON group. During late stance, reconstructed and contralateral limbs of the PCL group exhibited smaller knee extension moments (Δ = 0.24 N·m/kg [ P < .001] and Δ = 0.26 N·m/kg [ P < .001], respectively) and knee internal rotation moments (Δ = 0.06 N·m/kg [ P < .001] and Δ = 0.06 N·m/kg [ P < .001], respectively) compared with the CON group. No discrepancies were observed at the hip; minimal differences were noted in sagittal-plane ankle mechanics. Conclusion: Patients who underwent PCL reconstruction generally exhibited bilateral gait symmetry at 8 years after surgery. However, they exhibited important biomechanical deviations in both knees compared with healthy controls. These modifications likely reflect adaptive gait strategies to protect the PCL after reconstruction. Clinical Relevance: Long-term follow-up analyses of patients who underwent PCL reconstruction should not use the uninjured contralateral limb as a “healthy” reference, as it also exhibits mechanical differences compared with controls. Results could inform the development of neuromuscular and strength training programs targeting the restoration of knee biomechanics similar to healthy controls to prevent early-onset degeneration that is frequently associated with altered biomechanics.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries

et al. 2021

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“…8,9,70,142 Patients often start walking without assistance almost immediately after ACLR, 24 however some mechanics never fully recover after ACLR. In our systematic review, 180 we compiled data from all articles reporting peak kinematics and kinetics during walking gait with a comparison to a healthy control or contralateral limb. Data were organized by group (ACLR, ACL deficient (ACLD), healthy) and limb (involved, contralateral).…”

Section: Gait Changes After Anterior Cruciate Ligament Reconstructionmentioning

confidence: 99%

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

Slater

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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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Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis

Cited by 7 publications

References 9 publications

Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries

Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

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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