Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking

Abstract

Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees ( P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5–1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.

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

“…ACLD patients combined with higher severity degrees of meniscus tears (e.g., ACLDML vs. ACLDL) exhibited more abnormal knee joint contact forces and moments. These results supported our second hypothesis, which also confirmed previous findings that described the abnormal knee biomechanics after ACL and meniscal injuries during walking [ 16 , 23 ] and ascending stairs [ 24 ].…”

“…Various effects of meniscus injuries on knee joint stability showed that a combined ACL and meniscal injuries could alter the biomechanical response in different ways, depending on the type of meniscal tears. Ren et al [ 23 ] demonstrated a combination of “stiffening gait” and “pivot shift gait” patterns in ACLD knees with medial meniscus posterior horn tear, and this abnormal gait was confirmed by Liu et al [ 16 ] in ACLD combined with medial and lateral meniscus injury patients. However, these studies mainly focused on the measurement of kinematics and kinetics during gait [ 16 , 23 , 33 ] and ascending stairs [ 24 , 34 ] rather than running.…”

“…Interpatient differences in ACLD knees, with or without meniscal injury, have been reported by many studies [ 16 , 23 , 24 , 33 , 34 ]. Similar to our group category, Zhang et al performed two studies investigating kinematic characteristics during level walking [ 33 ] and ascending stairs [ 24 ].…”

“…For each subject, five successful running trials were recorded, and these results were imported into the multi-body dynamics software AnyBody Modeling System (version 6.0.5, AnyBody TM Technology, Aalborg, Denmark) to estimate kinetics of the knee joint. The method of combining a motion capture system and musculoskeletal model in AnyBody Modeling System for gait analysis has been clinically validated in many studies, such as knee osteoarthritis [ 15 , 16 ], muscle activity [ 17 , 18 ] and kinematic characteristics of children’s gait [ 19 ].…”

Biomechanics of the lateral meniscus: evidences from narrative review

“…The authors found a more posterior tibial translation and internal tibial rotation in the model without menisci. Liu et al ( 24 ) simulated a level walking from gait analysis of ACL-deficient patients with different meniscal lesions (either medial, lateral, and bilateral). Altered kinematics and kinetics were found in the presence of bilateral meniscectomy, with lower abduction-adduction and internal-external moment peaks compared to the control group.…”