Walking gait asymmetries 6 months following anterior cruciate ligament reconstruction predict 12‐month patient‐reported outcomes

Abstract

The study sought to determine the association between gait biomechanics (vertical ground reaction force [vGRF], vGRF loading rate [vGRF-LR]) collected 6 months following anterior cruciate ligament reconstruction (ACLR) with patient-reported outcomes at 12 months following ACLR. Walking gait biomechanics and all subsections of the Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected at 6 and 12 months following ACLR, respectively, in 25 individuals with a unilateral ACLR. Peak vGRF and peak instantaneous vGRF-LR were extracted from the first 50% of the stance phase. Limb symmetry indices (LSI) were used to normalize outcomes in the ACLR limb to that of the uninjured limb (ACLR/uninjured). Linear regression analyses were used to determine associations between biomechanical outcomes and KOOS while accounting for walking speed. Receiver operator characteristic curves were used to determine the accuracy of 6-month biomechanical outcomes for identifying individuals with acceptable patient-reported outcomes, using previously defined KOOS cut-off scores, 12 months post-ACLR. Individuals with lower peak vGRF LSI 6 months post-ACLR demonstrated worse patient-reported outcomes (KOOS Pain, Activities of Daily life, Sport and Recreation, Quality of Life) at the 12-month exam. A peak vGRF LSI ≥0.99 6 months following ACLR associated with 13.33× higher odds of reporting acceptable patient-reported outcomes 12 months post-ACLR. Lesser peak vGRF LSI during walking at 6-months post-ACLR may be a critical indicator of worse future patient-reported outcomes. Clinical significance achieving early symmetrical lower extremity loading and minimizing under-loading of the ACLR limb during walking may be a potential therapeutic target for improving patient-reported outcomes post-ACLR. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Operative and nonoperative management of anterior cruciate ligament injury: Differences in gait biomechanics at 5 years

“…For example, Hartigan et al reported that a lower external knee flexion moment during gait was a significant predictor of failing a functional return‐to‐sport test battery (quadriceps strength, single‐legged hop tests, and subjective knee function) at 6 months after ACL reconstruction 19 . Pietrosimone et al 20 reported that individuals who walk with lower vertical ground reaction forces compared with their uninjured limb at 6 months after ACL reconstruction present with lower scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) at 12 months after surgery. A secondary purpose was to compare knee extensor and flexor muscle forces during gait between individuals treated with operative compared with nonoperative management at 5 years after ACL injury.…”

Open-Source Remote Gait Analysis: A Post-Surgery Patient Monitoring Application

“…These results suggest a fundamental limitation of physical activity indices for monitoring rehabilitation progression. The vast majority of research investigating pathological biomechanics characteristic of gait following ACL-R suggests the existence of more sensitive metrics including quadriceps activation 43 , ground reaction force 33 , and joint work 34 . However, these metrics currently require laboratory-based methodologies that are not widely transferable to clinical use.…”

“…Previous research suggests that altered gait biomechanics following ACL-R are responsible for this phenomenon 31,32 . Pathological gait is often characterized by inter-limb asymmetries which manifest early in the post-surgical period 33–35 , and develop into compensatory gait patterns over time 11,36 . It is imperative that these maladaptations are identified early so that corrective rehabilitative interventions can be pursued 37 .…”

“…Platform modifications were context-specific and driven by the current understanding of the clinical problem. In the context of ACL-R, inter-limb gait asymmetry has been identified as a biomarker for recovery 33,34,38 . These asymmetries represent altered gait kinematics that are linked to PTOA-related knee joint contact forces in this population 11,39,40 .…”

Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14–16, 2019, Greensboro, NC

“…Greater loading of the ACLR limb has been demonstrated during gait compared with the contralateral limb 139 and the limbs of uninjured control participants. 140 Conversely, others have observed less loading of the ACLR limb during gait, and this reduced loading was associated with greater biochemical markers of inflammation 141 and cartilage breakdown, 142 altered cartilage composition, 143 worse patient-reported outcomes, 144 thinner tibiofemoral cartilage, 145 and radiographic knee OA 5 years after ACLR. 146 The mechanisms leading to abnormal amounts of more or less loading during gait after ACLR are not clear, but data presented at the retreat helped to shed light on potential mechanisms and stimulate directions for future research.…”