Gait mechanics and tibiofemoral loading in men of the ACL‐SPORTS randomized control trial

Abstract

The risk for post-traumatic osteoarthritis is elevated after anterior cruciate ligament reconstruction (ACLR), and may be especially high among individuals with aberrant walking mechanics, such as medial tibiofemoral joint underloading 6 months postoperatively. Rehabilitation training programs have been proposed as one strategy to address aberrant gait mechanics. We developed the anterior cruciate ligament specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of 10 post-operative training sessions consisting of strength, agility, plyometric, and secondary prevention exercises (SAPP) or SAPP plus perturbation (SAPP + PERT) training on gait mechanics after ACLR. A total of 40 male athletes (age 23 ± 7 years) after primary ACLR were randomized to SAPP or SAPP + PERT training and tested at three distinct, post-operative time points: 1) after impairment resolution (Pre-training); 2) following 10 training sessions (Post-training); and 3) 2 years after ACLR. Knee kinematic and kinetic variables as well as muscle and joint contact forces were calculated via inverse dynamics and a validated electromyography-informed musculoskeletal model. There were no significant improvements from Pre-training to Post-training in either intervention group. Smaller peak knee flexion angles, extension moments, extensor muscle forces, medial compartment contact forces, and tibiofemoral contact forces were present across group and time, however the magnitude of interlimb differences were generally smaller and likely not meaningful 2 years postoperatively. Neither SAPP nor SAPP + PERT training appears effective at altering gait mechanics in men in the short-term; however, meaningful gait asymmetries mostly resolved between post-training and 2 years after ACLR regardless of intervention group. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2364-2372, 2018.

Change in Drop-Landing Mechanics Over 2 Years in Young Athletes After Anterior Cruciate Ligament Reconstruction

“…To ameliorate alterations in knee biomechanics, clinicians may consider neuromuscular training as a potential intervention, as recent work from Nagelli and colleagues 38 demonstrated that a 12-session neuromuscular training program improved sagittal plane knee biomechanics during landing in individuals approximately 8 months after ACLR. However, in a recent study, Capin and collagues 6 found that a rehabilitation program that included neuromuscular and secondary-injury prevention exercises did not improve gait mechanics over time in individuals after ACLR. An important area of future work is to better understand what specific variables should be prioritized or targeted with neuromuscular training interventions to better improve movement patterns in this patient population.…”

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

“…Subjects showing greater magnitude of gait asymmetries in the first months may present similar imbalances when returning to running [25] and subsequently to sport [26], with walking adaptations detected up to 2 years after surgery [29]. Moreover, it is known that kinematic and kinetic alterations after ACL injury and surgery affect lower limbs bilaterally [30][31][32], with these alterations also occurring in the uninjured leg during walking activities [16,17,26,33]. This is further confirmed by our results showing significant changes over time in the non-operated leg, especially in the EG (Table 2).…”

“…In the midand long-term perspective, this is often associated with persistent thigh muscles weakness in the operated limb, thereby leading to a side-to-side asymmetry that alters normal knee and lower limb mechanics during daily motion [14,15]. For instance, during walking and functional tasks, reductions in the peak of knee flexion angle, external knee flexion moment, vertical impulse as well as posterior peak of ground reaction force have been observed in the operated limb of patients with ACL lesion and reconstruction [16][17][18][19]. Accordingly, after the reconstruction, it is well known that reaching a complete range of motion is one of the main goals of the early rehabilitation [4].…”

Quadriceps Strength Symmetry Does Not Modify Gait Mechanics After Anterior Cruciate Ligament Reconstruction, Rehabilitation, and Return-to-Sport Training

“…The majority of patients reached these return-to-sport milestones and subsequently were cleared to begin a return-to-sport progression (pending clearance from the surgeon); all returned to sport within 2 years, most to the same sport level. 9,10…”

“…4,10,14 Yet, clinically meaningful gait asymmetries 19 persist well beyond return-to-sport clearance, up to 5 years after ACLR. 10,24,32,33 While quadriceps strength is associated with aberrant gait mechanics early after ACLR, 36 it is not clear if that relationship persists after return-to-sport training or if other factors drive persistent gait asymmetries. The association between symmetry in isometric quadriceps strength and aberrant gait mechanics among patients who have undergone rehabilitation and return-to-sport training after ACLR is unknown.…”