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

Abstract

Gait biomechanics after anterior cruciate ligament (ACL) injury are associated with functional outcomes and the development of posttraumatic knee osteoarthritis. However, biomechanical outcomes between patients treated nonoperatively compared with operatively are not well understood. The primary purpose of this study was to compare knee joint contact forces, angles, and moments during loading response of gait between individuals treated with operative compared with nonoperative management at 5 years after ACL injury. Forty athletes treated operatively and 17 athletes treated nonoperatively completed gait analysis at 5 years after ACL reconstruction or completion of nonoperative rehabilitation. Medial compartment joint contact forces were estimated using a previously validated, patient‐specific electromyography‐driven musculoskeletal model. Knee joint contact forces, angles, and moments were compared between the operative and nonoperative group using mixed model 2 × 2 analyses of variance. Peak medial compartment contact forces were larger in the involved limb of the nonoperative group (Op: 2.37 ± 0.47 BW, Non‐Op: 3.03 ± 0.53 BW; effect size: 1.36). Peak external knee adduction moment was also larger in the involved limb of the nonoperative group (Op: 0.25 ± 0.08 Nm/kg·m, Non‐Op: 0.32 ± 0.09 Nm/kg·m; effect size: 0.89). No differences in radiographic tibiofemoral osteoarthritis were present between the operative and nonoperative groups. Overall, participants treated nonoperatively walked with greater measures of medial compartment joint loading than those treated operatively, while sagittal plane group differences were not present. Statement of clinical relevance: The differences in medial knee joint loading at 5 years after operative and nonoperative management of ACL injury may have implications on the development of posttraumatic knee osteoarthritis.

Cartilage Matrix Degeneration Occurs within the First Year after ACLR and Is Associated with Impaired Clinical Outcome

“…Although arthroscopic assessments in the current work were collected on some knees still in an acute injury phase, cartilage compositional changes were assessed exclusively after surgery, as the baseline MRI here was acquired 6 weeks after ACLR. That subtle difference is relevant to understanding the evolution of pre-OA following ACLR, specifically in the postsurgical knee where cartilage is exposed to a different mechanical 27,32,33 and biological environment [34][35][36][37] compared with freshly injured and unreconstructed joints. Although the longitudinal cartilage T2 increases observed in this study occurred in the context of the postsurgical joint, effects of the initial injury contribute to the sum total of the post-ACLR environment.…”

Impact of Rehabilitation on Gait Kinematic following Grade II Anterior Cruciate Ligament Injury among Wrestlers

“…It has been reported in previous studies that the gait pattern may affect following ACL injuries [ 4 – 6 ]. The ACL injury may result in loss of knee joint stability and abnormal movement patterns, leading to the early development of degenerative changes such as osteoarthritis of the knee joint [ 7 ].…”

“…Button et al [ 14 ] reported no difference in sagittal plane knee angle and movements in patients who undergone ACL rehabilitation compared to healthy controls. According to Khandha et al [ 4 ], the patient who received rehabilitation protocol following ACL injury walked with 28% greater medial compartment contact forces and 28% greater peak knee adduction moment in the involved knee compared with patients who have undergone ACL reconstruction surgery. Even though there are several studies available in the literature about the changes in gait kinematics following ACL injury and ACL reconstruction surgery [ 11 , 15 ], none of these studies investigated the changes in gait kinematics following nonoperative ACL rehabilitation protocol.…”

Effect of knee joint loading on chondrocyte mechano-vulnerability and severity of post-traumatic osteoarthritis induced by ACL-injury in mice

“…ACL, a ligament directly connecting the femur to the tibia, stabilizes the knee joint in the anterior-to-posterior direction, prevents anterior-tibial subluxation, as well as provides rotational stability. A sudden turn or noncontact mechanism typically causes an ACL tear resulting in knee subluxation, pivot shift, and joint instability indicated in altered joint kinematics and gait patterns [21][22][23][24][25][26][27] .…”