Three-dimensional knee moments of ACL reconstructed and control subjects during gait, stair ascent, and stair descent

Abstract

Changes in knee mechanics following anterior cruciate ligament reconstruction (ACLR) have been implicated as a contributor to the development of premature osteoarthritis (OA). However, changes in ambulatory loading in this population have not been well documented. While the magnitude of the external knee moment vector is a major factor in loading at the knee, there is not a comprehensive understanding of the changes in the individual components of the vector following ACL reconstruction. The purpose of this study was to test for differences in the three components of the external knee moment during walking and stair locomotion between ACLR, contralateral and healthy control knees. Forty-five ACLR and 45 healthy control subjects were tested during walking, stair ascent and descent. ACLR knees had a lower first peak adduction moment than contralateral knees during all three activities. Similarly, additional cases of significant differences between ACLR and contralateral knees consisted of lower peak moments for the ACLR than the contralateral knees. These differences were due to both ACLR and contralateral knees as the ACLR knees indicated lower and the contralateral knees greater peak moments compared to healthy control knees. The results suggest a compensatory change involving greater loading in the contralateral knee, perhaps due to lower loading of the ACLR knee. Further, lower knee moments of the ACLR knee suggest that increased joint loading may not be the initiating factor in the development of OA following ACL reconstruction; but rather previous described kinematic or biological changes might initiate the pathway to knee OA.

Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

“…In individuals who were 6–12 months post-ACLR, there was moderate evidence from pooled data from three studies (two low- and one high-quality) for smaller peak knee flexion moment than controls (−0.76, −1.40 to −0.12; I 2 =52%, p=0.12),18 30 31 and limited evidence from two studies (one low- and one high-quality) for no difference in peak knee extension moment (−2.25, −7.00 to 2.50; I 2 =98%, p<0.0001) 18 30. In individuals 1–3 years after ACLR, pooled data from two moderate-quality studies provided moderate evidence of no difference in peak knee flexion moment (−0.24, −0.58 to 0.10; I 2 =0%, p=0.52),32 33 while very limited evidence of no difference in peak knee extension moment (−0.40, −0.82 to 0.02) was provided by one moderate-quality study 32. In those who were ≥3 years post-ACLR, a single high-quality study provided limited evidence of no difference in peak knee extension moment 34.…”

Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

“…11,12 Impaired quadriceps motor function is concerning to clinicians and scientists due to the primary role the quadriceps play in lower extremity locomotion, force attenuation, and functional stability about the knee. Deficient quadriceps motor function may contribute to abnormal movement strategies that patients with ACL-R demonstrate during walking, 13 jogging, 14 and landing. 15 Quadriceps motor dysfunction is commonly evaluated during knee-extension contractions.…”

Altered Tibiofemoral Kinematics in the Affected Knee and Compensatory Changes in the Contralateral Knee After Anterior Cruciate Ligament Reconstruction

“…Previous studies have also focused on activities such as squatting, level ground walking, and running, 26,29 which may not represent knee function during complex, highimpact, multiplanar loading conditions, including dynamic jumping, pivoting, and rapid cutting activities that may generate much higher ACL loads. 30,36 The majority of ACL injuries occur during a noncontact maneuver involving the described jump landing and cutting movements. 9,30 Hence, single-legged hop landing tasks have been considered comparable with more strenuous jumping and cutting movements as seen in high-level sports (eg, basketball and volleyball).…”