Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR

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

doi:10.1002/jor.24822

Cited by 10 publications

(9 citation statements)

References 47 publications

(96 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%

“…Recent evidence suggests that inadequate loading of the involved knee during the first 50% of the stance phase in gait may contribute to OA development (4)(5)(6)(7). Studies have focused heavily on asymmetries in the peak magnitude of gait kinetics, kinematics, and joint contact forces to identify pathological gait after ACLR (8)(9)(10)(11)(12)(13). The temporal characteristics of knee kinetics and EMG leading up to the peaks, such as the knee flexion rate of moment development (RMD), knee flexion moment impulse (KFMI) (14,15), or timing of motor input from the quadriceps relative to knee flexion moment, however, have not been rigorously evaluated.…”

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confidence: 99%

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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%

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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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“…Limb underloading is one of the most consistent gait compensations observed in those with ACLR—typically shown as a reduced peak sagittal knee moment and vertical GRF during the first half of stance (27,37–39). Indeed, our data suggest that the ACLR limb exhibited smaller vertical GRF magnitudes during early and late stances, but larger vertical GRF magnitudes during the midstance phase when compared with the contralateral limb (Fig.…”

Section: Discussionmentioning

confidence: 99%

Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics

Garcia

Pamukoff

Johnson

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose Individuals with anterior cruciate ligament reconstruction (ACLR) generally exhibit limb underloading behaviors during walking, but most research focuses on per-step comparisons. Cumulative loading metrics offer unique insight into joint loading as magnitude, duration, and total steps are considered, but few studies have evaluated if cumulative loads are altered post-ACLR. Here, we evaluated if underloading behaviors are apparent in ACLR limbs when using cumulative load metrics and how load metrics change in response to walking speed modifications. Methods Treadmill walking biomechanics were evaluated in 21 participants with ACLR at three speeds (self-selected (SS); 120% SS and 80% SS). Cumulative loads per step and per kilometer were calculated using knee flexion and adduction moment (KFM and KAM) and vertical ground reaction force (GRF) impulses. Traditional magnitude metrics for KFM, KAM, and GRF were also calculated. Results The ACLR limb displayed smaller KFM and GRF in early and late stances, but larger KFM and GRF during midstance compared with the contralateral limb (P < 0.01). Only GRF cumulative loads (per step and per kilometer) were reduced in the ACLR limb (P < 0.01). In response to speed modifications, load magnitudes generally increased with speed. Conversely, cumulative load metrics (per step and per kilometer) decreased at faster speeds and increased at slow speeds (P < 0.01). Conclusions Patients with ACLR underload their knee in the sagittal plane per step, but cumulatively over the course of many steps/distance, this underloading phenomenon was not apparent. Furthermore, cumulative load increased at slower speeds, opposite to what is identified with traditional single-step metrics. Assessing cumulative load metrics may offer additional insight into how load outcomes may be impacted in injured populations or in response to gait modifications.

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“…In this investigation, the experimental group showed a greater knee flexion angle (about + 10°) of the injured leg as well as a better side-to-side limb symmetry in the 1 st peak of antero-posterior GRF (about + 28%) compared to control group during the stance phase of walking two months after surgery. Gait asymmetries have long been identified as a common surgery-related problem in the early rehabilitation after ACL reconstruction [25][26][27], Table 2 Mean (SD) of normalized kinetic parameters at different time measures for EG and CG groups in the healthy and injured leg. P values of significant effect of Time and Group interaction are provided.…”

Section: Discussionmentioning

confidence: 99%

Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation

Rocchi

Labanca

Luongo

et al. 2020

BMC Musculoskelet Disord

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Background The use of knee braces early after anterior cruciate ligament (ACL) reconstruction is a controversial issue. The study preliminarily compares the effect of a traditional brace blocked in knee extension and a new functional brace equipped with a spring resistance on walking and strength performance early after ACL reconstruction performed in the acute/subacute stage. Methods 14 ACL-reconstructed patients wore either a traditional (Control group: CG, 7 subjects) or a new functional brace (Experimental group: EG 7 subjects) until the 30th post-operative day. All patients were tested before surgery (T0), 15, 30, and 60 days after surgery (T1, T2, and T3, respectively). Knee angular displacement and ground reaction forces (GRF) during the stance phase of the gait cycle were analyzed at each session and, at T3, maximal voluntary isometric contraction (MVIC) for knee flexor/extensor muscles was performed. Limb symmetry indexes (LSI) of GRF and MVIC parameters were calculated. Results At T3, EG showed greater peak knee flexion angle of injured limb compared to CG (41 ± 2° vs 32 ± 1°, p < 0.001). During weight acceptance, a significant increase of anteroposterior GRF peak and vertical impulse from T1 to T3 was observed in the injured limb in EG (p < 0.05) but not in CG (p > 0.05). EG showed a greater side-to-side LSI of weight acceptance peak of anteroposterior GRF at T2 (113 ± 23% vs 69 ± 11%, p < 0.05) and T3 (112 ± 23% vs 84 ± 10%, p < 0.05). Conclusions The preliminary findings from this study indicate that the new functional brace did help in improving gait biomechanical pattern in the first two months after ACL reconstruction compared to a traditional brace locked in knee extension.

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Sex and mechanism of injury influence knee joint loading symmetry during gait 6 months after ACLR

Cited by 10 publications

References 47 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

Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics

Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation

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