Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics

Abstract

Body mass index (BMI) and history of anterior cruciate ligament reconstruction (ACLR) independently influence gait biomechanics and knee osteoarthritis risk, but the interaction between these factors is unclear. The purpose of this study was to compare gait biomechanics between individuals with and without ACLR, and with and without overweight/obesity. We examined 104 individuals divided into four groups: with and without ACLR, and with low or high BMI (n = 26 per group). Three-dimensional gait biomechanics were evaluated at preferred speed. The peak vertical ground reaction force, knee flexion angle and excursion, external knee flexion moment, and external knee adduction moment were extracted for analysis. Gait features were compared between groups using 2 (with and without overweight/obesity) × 2 (with and without ACLR) analysis of variance. Primary findings indicated that those with ACLR and high BMI had a larger external knee adduction moment compared with those with low BMI and with (p = 0.004) and without ACLR (p = 0.005), and compared with those without ACLR and high BMI (p = 0.001). The main effects of ACLR and BMI group were found for the knee flexion moment, and those with ACLR and with high BMI had lower knee flexion moments compared with those without ACLR (p = 0.031) and with low BMI (p = 0.021), respectively. Data suggest that individuals with ACLR and high BMI may benefit from additional intervention targeting the knee adduction moment. Moreover, lower external knee flexion moments in those with high BMI and ACLR were consistent, but high BMI did not exacerbate deficits in the knee flexion moment in those with ACLR. [Correction added on 9 November 2022, after first online publication: In the preceding sentence, for clarity, the words "reductions in the lower" was removed from the initial sentence to read "Moreover, lower external knee flexion moments".]

Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention

“…Since the ACL reconstruction postural control deficit is a chronic condition, longer follow-up periods would be beneficial to detect the impacts of interventions that could appear subsequently and also allows comparing the outcomes in various periods. Another thing is that some parameters such as weight and age can affect protocol effectiveness, 26,27 which is important to pay attention to it. In this regard, it will be noted that the groups are well justified during the protocol.…”

Cartilage deformation following a walking bout in individuals with anterior cruciate ligament reconstruction

“…The knee adduction moment may have different effects on cartilage based on disease state and other moderating factors (e.g., age, obesity, inflammation) 45,46 . Comparisons of the external knee adduction moment between knees with and without ACLR are inconsistent, with some reporting a larger, smaller, or equivocal knee adduction moment in the ACLR compared with contralateral or control limb 19–22 . Studies are needed to further evaluate the role of the knee adduction moment in knee OA progression after ACLR.…”

“…16,17 Conversely, a higher knee adduction moment is associated with knee OA progression 18 but is inconsistently affected by ACLR. [19][20][21][22] Loading outcomes during gait have also been linked to cartilage characteristics. For instance, a larger knee flexion moment but smaller knee adduction moment during gait was associated with thicker femoral cartilage in those with ACLR.…”

“…As such, limbs with ACLR walk with smaller peak knee flexion angles, less knee flexion excursion, and smaller external knee flexion moments when compared with contralateral or control limbs 16,17 . Conversely, a higher knee adduction moment is associated with knee OA progression 18 but is inconsistently affected by ACLR 19–22 . Loading outcomes during gait have also been linked to cartilage characteristics.…”