The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees

Abstract

Gait alterations after ACL reconstruction have been reported in the literature. The current study examined a group of 14 patients who all had an ACL reconstruction with a patellar tendon autograft. Kinetic and kinematic data were obtained from the knee during walking. The flexion-extension deficit (FED) calculated from the angular difference between maximal flexion and maximal extension during the stance phase in the ACL-reconstructed and the normal knee was measured. We investigated whether these alterations in gait are related to quadriceps strength and residual laxity of the knee. It may be that patients modify their gait patterns to protect the knee from excessive anterior translation of the tibia by reducing the amount of extension during stance. On the other hand, persistent quadriceps weakness may also cause changes in gait patterns as the quadriceps is functioning as an important dynamic stabilizer of the knee during stance. Results showed that patients had a significantly higher FED value (4.9+/-4.0) than a healthy control group in a previous study (1.3+/-0.9). This is caused mainly by an extension deficit during midstance. External extension moments of the knee (TZMAX were significantly lower in the current patients group than in a healthy control group (TZMAX -0.27+/-0.19 Nm/kg in patients vs. -0.08+/-0.06 Nm/kg in controls). There were no significant correlations between quadriceps strength and gait analysis parameters. Furthermore no correlation was found between the amount of laxity of the knee and gait. The relevance of this study lies in the fact that apparently the measured gait alterations cannot be explained solely by often used biomechanical indicators such as laxity and strength. The measured gait alterations may be a result of the surgical procedure with subsequent modified motor programming.

Gait Patterns after Anterior Cruciate Ligament Reconstruction are Related to Graft Type

“…4,20,23 This association has, however, mainly been seen for high-impact activities such as jogging but not for walking. 4,16,23 In the present study, we found no relationship between quadriceps or hamstring muscle strength and joint moments during comfortablespeed walking in the control, hamstring tendon, or patellar tendon groups.…”

Isokinetic muscle strength and readiness to return to sport following anterior cruciate ligament reconstruction: is there an association? A systematic review and a protocol recommendation

“…Seven were classified as good,43 45–47 53 55 66 26 as fair3 5–9 21 23 37–39 41 42 44 48–50 52 54 56 60–67 and 6 as poor 29 40 51 57–59. Thirty studies did not include all important adverse events that could have an effect on the intervention reported (criterion 8),5–7 9 21 23 29 38–40 42–52 54 56 57 59 60 63 64–67 23 studies did not adequately describe the source population and how they were recruited (criterion 11 and 12),3 5 6 8 21 37–40 42 44 48–52 54 57–60 64 65 24 studies did not describe if the source population was recruited in the same time period (criterion 22),3 8 9 23 29 37–42 44 48–52 54–58 63 64 66 and 29 studies did not report sample size calculation (criterion 27) 3 6–8 21 23 29 38–44 49–53 56–61 63–67. Other criterion, such as criterion 22 and 23, were not commonly fulfilled due to most studies not being randomised, while criterion 14 and 15 were not commonly reported due to lack of blinding.…”

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

“…For example, sideto-side symmetry is widely utilized in orthopedic surgery and has been shown to be suitable for quantitative analysis of ligament laxity, 31 muscle strength, 32 cartilage thickness, 33 and ACL volume. 34 In contrast, recent studies 35,36 of side-to-side differences in native ACL footprint position reported a side-to-side asymmetry in ACL position with mean differences greater than 4.5 mm in both the tibia and femur of cadaveric knees.…”