Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting

Abstract

BackgroundAnterior cruciate ligament (ACL) deficiency leads to altered stability of the knee. The purpose of this study was to compare the dynamic, rotational stability of the knee, expressed as rotational stiffness, between anterior cruciate ligament-deficient (ACLD) knees, their contralateral intact knees (ACLI) and a knee healthy control group during walking, running and 90° pivoting. We hypothesized a larger tibial internal rotation, a smaller knee joint external moment and a lower rotational stiffness in the ACLD group compared to the ACLI and the control group.MethodsKinematic and kinetic data were collected from both legs of 44 ACLD patients and 16 healthy controls during walking, running and a pivoting maneuver (descending a staircase and immediately pivoting 90° on the landing leg). Motion data were captured using 8 high-speed cameras and a force-plate. Reflective markers were attached to bony landmarks of the lower limb and rigid clusters on the shank and thigh (CASH model). Maximum internal tibial rotation and the corresponding rotational moment were identified for all tasks and groups and used to calculate rotational stiffness (= Δmoment /Δrotation) of the knee.ResultsThe tibial internal rotation of the ACLD knee was not significantly different from the ACLI knee during all three tasks. During walking and running, the tibial rotation of the control group was significantly different from both legs of the ACL-injured patient. For pivoting, no difference in tibial rotation between knees of the ACLD, ACLI and the control group was found. Knee joint external moments were not significantly different between the three groups during walking and pivoting. During running, the moments of the ACLI group were significantly higher than both the knees of the ACLD and the control group. Rotational stiffness did not differ significantly between groups in any of the three tasks.ConclusionA high-intensity activity combining stair descent and pivoting produces similar angular rotations, knee joint external moments and rotational stiffness in ACLD knees compared to ACLI knees and the control group. During running, the ACLI knee displayed a higher external moment than the ACLD and the healthy control group. This could indicate some type of protective strategy or muscular adaptation in the ACL-injured patients.

Adaptability of a jump movement pattern to a non-constant force field elicited via centrifugation

“…From studies comparing vertical jumps and cutting maneuvers, it is known that jumps evoke relatively low knee adduction/abduction moments compared to cutting maneuvers [15] or pivot tasks [16], so even the slightly increased knee adduction moments observed in the left leg during higher g-levels should not entail a significantly increased risk of injury. Similarly, the increase in knee internal rotation moments during centrifugation is comparable to the increase reported for cutting maneuvers compared to vertical jumps [15], and pivot tasks [17].…”

Identification of Kinetic Abnormalities in Male Patients after Anterior Cruciate Ligament Deficiency Combined with Meniscal Injury: A Musculoskeletal Model Study of Lower Limbs during Jogging

“…The difference may result from the running speed, in which the velocity of the control group is lower in this study, 2.33 m/s, compared to the author’s report of 4.24 m/s. The knee rotational moment was reported by some studies, which found a lower rotational moment in ACLD [ 8 ] and ACL reconstruction [ 27 ] knees compared to healthy limbs. The range of knee rotational moment for the control group compared favorably (0.07–0.13 Nm/(Bw × Bh) in [ 8 ] vs. 0.04–0.10 Nm/(Bw × Bh) in this study), and the peak value was similar to [ 27 ] when changing the unit to (body mass and leg length).…”

“…Some studies have found abnormal changes in ACLD [ 8 ] and reconstruction [ 3 , 6 , 7 ] knees during running. However, they did not report the alteration of contact forces, which is closely related to the development of osteoarthritis.…”

“…Existing literature on the knee joint kinetic analysis during running mainly concentrated on isolated ACLD injuries, and the results were inconsistent due to different methodologies [ 8 ]. Although it was difficult to make a direct comparison with current studies, a similar trend towards decreased knee joint kinetics was detected both in contact forces [ 25 ] and moments [ 26 ] after ACL reconstruction.…”

“…Asaeda et al [ 7 ] investigated the relationship between knee muscle strength and knee biomechanics and found that both males and females were unable to restore their normal knee biomechanics from 3 months to 5 years. Moreover, some researchers [ 8 , 9 , 10 ] studied the knee mechanic alterations in ACLD patients during running and showed that kinematics changed both in the injured and uninjured knees. However, the effect of meniscus injuries on the ACLD knees during jogging is rarely reported.…”