The relationship between quadriceps strength asymmetry and knee biomechanics asymmetry during walking in individuals with anterior cruciate ligament reconstruction

Shi, Huijuan; Huang, Hongshi; Ren, Shuang; Yu, Yuanyuan; Liang, Zixuan; Wang, Qi; Hu, Xiaoqing; Ao, Yingfang

doi:10.1016/j.gaitpost.2019.07.151

Cited by 37 publications

(26 citation statements)

References 34 publications

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“…In a cohort 6 to 10 months after ACLR, Shi et al 52 found that asymmetric quadriceps strength was significantly related to asymmetry in knee flexion angle and knee extensor moment during the stance phase of gait. This cohort, however, included patients 6 to 10 months after ACLR without quadriceps strength symmetry restoration (isometric quadriceps strength: involved limb, 0.94 ± 0.28 N·m/kg/m; uninvolved limb, 1.26 ± 0.28 N·m/kg/m; P < .001).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: After anterior cruciate ligament (ACL) reconstruction (ACLR), biomechanical asymmetries during gait are highly prevalent, persistent, and linked to posttraumatic knee osteoarthritis. Quadriceps strength is an important clinical measure associated with preoperative gait asymmetries and postoperative function and is a primary criterion for return-to-sport clearance. Evidence relating symmetry in quadriceps strength with gait biomechanics is limited to preoperative and early rehabilitation time points before return-to-sport training. Purpose/Hypothesis: The purpose was to determine the relationship between symmetry in isometric quadriceps strength and gait biomechanics after return-to-sport training in athletes after ACLR. We hypothesized that as quadriceps strength symmetry increases, athletes will demonstrate more symmetric knee joint biomechanics, including tibiofemoral joint loading during gait. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Of 79 athletes enrolled in the ACL-SPORTS Trial, 76 were participants in this study after completing postoperative rehabilitation and 10 return-to-sport training sessions (mean ± SD, 7.1 ± 2.0 months after ACLR). All participants completed biomechanical walking gait analysis and isometric quadriceps strength assessment using an electromechanical dynamometer. Quadriceps strength was calculated using a limb symmetry index (involved limb value / uninvolved limb value × 100). The biomechanical variables of interest included peak knee flexion angle, peak knee internal extension moment, sagittal plane knee excursion at weight acceptance and midstance, quadriceps muscle force at peak knee flexion angle, and peak medial compartment contact force. Spearman rank correlation (ρ) coefficients were used to determine the relationship between limb symmetry indexes in quadriceps strength and each biomechanical variable; alpha was set to .05. Results: Of the 76 participants, 27 (35%) demonstrated asymmetries in quadriceps strength, defined by quadriceps strength symmetry <90% (n = 23) or >110% (n = 4) (range, 56.9%-131.7%). For the biomechanical variables of interest, 67% demonstrated asymmetry in peak knee flexion angle; 68% and 83% in knee excursion during weight acceptance and midstance, respectively; 74% in internal peak knee extension moment; 57% in medial compartment contact force; and 74% in quadriceps muscle force. There were no significant correlations between quadriceps strength index and limb symmetry indexes for any biomechanical variable after return-to-sport training ( P > .129). Conclusion: Among those who completed return-to-sport training after ACLR, subsequent quadriceps strength symmetry was not correlated with the persistent asymmetries in gait biomechanics. After a threshold of quadriceps strength is reached, restoring strength alone may not ameliorate gait asymmetries, and current clinical interventions and return-to-sport training may not adequately target gait.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…A previous study found that neuromuscular control is related to interlimb asymmetry in patients undergoing ACL reconstruction, and a neuromuscular training program can significantly improve interlimb asymmetry. 23 As movement asymmetries could contribute to the development or progression of posttraumatic knee osteoarthritis, 4,25 more asymmetries during walking could cause a higher risk for posttraumatic osteoarthritis in the ACLD + MMPHT group than in the ACLD group. 16 Neuromuscular training in patients with ACL rupture and MMPHT could help to improve interlimb asymmetry to prevent or delay the initiation and development of osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament–Deficient Patients With and Without Medial Meniscal Posterior Horn Tears

Ren

Shi

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Patients with anterior cruciate ligament–deficient (ACLD) knees with medial meniscal posterior horn tears (MMPHTs) have been reported to demonstrate a combined stiffening and pivot-shift gait pattern compared with healthy controls. Movement asymmetries are implicated in the development and progression of osteoarthritis. Purpose: To investigate the knee kinematics and kinetic asymmetries in ACLD patients with (ACLD + MMPHT group) and without (ACLD group) MMPHTs while walking on level ground. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 15 patients with isolated unilateral ACL ruptures, 10 with unilateral ACL ruptures and MMPHTs, and 22 healthy controls underwent gait testing between January 2014 and December 2016. Between-leg differences (BLDs) in knee kinematics and kinetics were compared among participants in all groups. Results: The ACLD + MMPHT group demonstrated significantly greater BLDs in knee moments in the sagittal plane during the loading response phase than the ACLD and control groups. Compared with the control group, the ACLD and ACLD + MMPHT groups demonstrated significantly greater BLDs in knee angles in the sagittal plane during the midstance and terminal stance phases. Compared with the control group, significantly greater BLDs in knee rotation moments were found throughout the stance phase in both the ACLD and the ACLD + MMPHT groups. BLDs in lateral ground-reaction forces (GRFs) in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. BLDs in anterior GRFs in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. Only the ACLD + MMPHT group demonstrated greater BLDs in vertical GRFs than the control group during the loading response phase, while no significant differences were observed between the ACLD and control groups. Conclusion: The ACLD + MMPHT group demonstrated significantly more knee flexion moment asymmetries than the ACLD and control groups during the loading response phase. Both the ACLD + MMPHT and the ACLD groups demonstrated significant knee angle and moment asymmetries in the sagittal plane during the terminal stance phase than the control group. Both the ACLD + MMPHT and the ACLD groups demonstrated knee rotation moment asymmetries during the midstance and terminal stance phases compared with the control group. A rehabilitation program for ACLD patients both with and without MMPHTs should take into consideration these asymmetric gait patterns.

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“…Asymmetric gait is a common problem in many patient populations [1][2][3][4][5][6][7][8][9][10]. Asymmetry during gait can result from imbalances in physical properties of the extremities such as disproportionate leg lengths or masses [10], imbalances in muscle strength, resting length, and flexibility [11][12][13], or neurological deficits that can occur at several levels of the nervous system [14][15][16]. Gait asymmetry is a concern for rehabilitation professionals because it can lead to increased risk of fall by hindering appropriate reactions to perturbation [4][5][6][7][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…Gait asymmetry is a concern for rehabilitation professionals because it can lead to increased risk of fall by hindering appropriate reactions to perturbation [4][5][6][7][17][18][19][20][21]. Asymmetric loading during gait can also result in pain and degenerative changes in the spine, knee, and hip [13,22,23].…”

Section: Introductionmentioning

confidence: 99%

Walking on a Vertically Oscillating Platform with Simulated Gait Asymmetry

Alyami

Nessler

2021

Symmetry

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Asymmetric gait is associated with pain, injury, and reduced stability in patient populations. Data from side by side walking suggest that unintentional synchronization with an external cue may reduce gait asymmetry. Two types of asymmetric gait were examined here: (1) mass imbalance between limbs to simulate single limb amputation and (2) restriction of plantarflexion during toe-off to simulate reduced propulsion from neurological impairment. Twenty-five healthy participants walked normally and with simulated gait asymmetry on a custom-designed treadmill that oscillated in the vertical direction via pneumatic actuation (amplitude: 2 cm, frequency: participant’s preferred step frequency). Swing Time Asymmetry (STA) and Phase Coordination Index (PCI) both increased significantly with the application of unilateral mass and plantarflexion restriction (p < 0.001). However, walking with simulated asymmetry did not alter unintentional synchronization with the treadmill motion. Further, oscillation of the treadmill did not improve STA or PCI while walking with simulated asymmetry. Analysis of synchronized step clusters using the Weibull survival function revealed that synchronization with the platform persisted for longer durations when compared with data from side by side walking. These results suggest that walking on a vertically oscillating surface may not be an effective approach for improving gait asymmetry.

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The relationship between quadriceps strength asymmetry and knee biomechanics asymmetry during walking in individuals with anterior cruciate ligament reconstruction

Cited by 37 publications

References 34 publications

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

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

Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament–Deficient Patients With and Without Medial Meniscal Posterior Horn Tears

Walking on a Vertically Oscillating Platform with Simulated Gait Asymmetry

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