Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction

Evans‐Pickett, Alyssa; Lisee, Caroline; Horton, W Zachary; Lalush, David S.; Nissman, Daniel; Blackburn, J. Troy; Spang, Jeffrey T.; Pietrosimone, Brian

doi:10.1249/mss.0000000000002969

Cited by 10 publications

(16 citation statements)

References 49 publications

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“…a bone-patellar tendon-bone autograft ACLR by one of three participating orthopedic surgeons. Individuals were excluded if they reported any of the following: ACLR revision surgery; multi-ligament reconstruction at the time of ACLR; removal of >1/3 of their meniscus at the time of ACLR (30)(31)(32); contralateral ACLR or injury; history of any other lower extremity orthopedic surgery; physician diagnosed knee osteoarthritis; history of neuromuscular disorders, balance disorders, or inflammatory arthritis; history of other orthopedic/musculoskeletal injury within 6 months prior to enrollment and testing; or were pregnant (4,5,12,13). All participants underwent formalized physical rehabilitation following ACLR, yet we did not standardize therapy for this group.…”

Section: Methodsmentioning

confidence: 99%

“…ollowing anterior cruciate ligament reconstruction (ACLR), nearly one third of individuals develop radiographic posttraumatic osteoarthritis (PTOA) within the first decade and approximately half develop PTOA by the second decade (1,2). It is hypothesized that aberrant gait biomechanics hasten the development of PTOA in individuals with an ACLR (3)(4)(5). Aberrant gait biomechanical patterns demonstrated by individuals following ACLR are associated with greater concentrations of biomarkers related to deleterious changes in joint tissue metabolism (3,(6)(7)(8) and articular cartilage composition (4,5,9,10,12) which are linked to PTOA development.…”

mentioning

confidence: 99%

“…It is hypothesized that aberrant gait biomechanics hasten the development of PTOA in individuals with an ACLR (3)(4)(5). Aberrant gait biomechanical patterns demonstrated by individuals following ACLR are associated with greater concentrations of biomarkers related to deleterious changes in joint tissue metabolism (3,(6)(7)(8) and articular cartilage composition (4,5,9,10,12) which are linked to PTOA development. Specifically, compared with uninjured controls, ACLR patients walk slower and demonstrate less dynamic loading of the ACLR limb, as characterized by smaller first and second peak vertical ground reaction forces (vGRF) and greater vGRF during midstance (4,12,13).…”

mentioning

confidence: 99%

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Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction

Buck,

Lisee,

Bjornsen

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Aberrant gait biomechanics in individuals with anterior cruciate ligament reconstruction (ACLR) are linked to posttraumatic osteoarthritis (PTOA) development, indicating a need to normalize gait biomechanics to prevent PTOA. ACLR individuals walk slower than uninjured controls and slower speeds are associated with aberrant gait biomechanics. Yet, it is unclear if increasing walking speed normalizes gait biomechanics post-ACLR. Purpose To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared to their habitual speed and uninjured matched-controls. Methods Gait biomechanics were collected on 30 ACLR individuals (20 females, age: 22.0 ± 4.2 years, BMI: 24.0 ± 3.0 kg·m-2) at their habitual speed and at 1.3 m·s-1, a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, BMI: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s-1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s-1 vs controls. Results In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s-1) and 1.3 m·s-1 (1.29 ± 0.05 m·s-1). Compared with controls (habitual speed: 1.34 ± 0.12 m·s-1), the ACLR group while walking at 1.3 m·s-1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13-28, 78-90% stance phase), greater midstance vGRF (47-61%), smaller early-to-midstance knee flexion angle (KFA; 1-44%), greater mid-to-late stance KFA (68-73, 96-101%), greater internal knee abduction moment (69-101%), and smaller internal knee extension moment (4-51, 88-96%). Conclusions Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction

Buck,

Lisee,

Bjornsen

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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“…ersons with anterior cruciate ligament reconstruction (ACLR) often display maladaptive walking patterns that are resistant to therapeutic strategies and persist after the completion of formal rehabilitation (1). Generally, maladaptive walking patterns are reflective of a compensatory strategy that results in a relative underloading of the surgical limb compared with the contralateral limb and controls (2,3). Underloading after ACLR has been theorized to be an early driver of posttraumatic osteoarthritis (OA) given the strong influence of mechanical loading on cartilage health and function (4,5).…”

mentioning

confidence: 99%

“…Underloading after ACLR has been theorized to be an early driver of posttraumatic osteoarthritis (OA) given the strong influence of mechanical loading on cartilage health and function (4,5). For instance, evidence of reduced joint loading after ACLR has been linked with imaging biomarkers of early cartilage degeneration and a higher risk of displaying radiographic signs of OA (2,(6)(7)(8)(9). Therefore, research to understand the extent of aberrant loading characteristics after ACLR is critical to enhance knowledge of the mechanical contributors to OA.…”

mentioning

confidence: 99%

Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics

Garcia

Pamukoff

Johnson

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose Individuals with anterior cruciate ligament reconstruction (ACLR) generally exhibit limb underloading behaviors during walking, but most research focuses on per-step comparisons. Cumulative loading metrics offer unique insight into joint loading as magnitude, duration, and total steps are considered, but few studies have evaluated if cumulative loads are altered post-ACLR. Here, we evaluated if underloading behaviors are apparent in ACLR limbs when using cumulative load metrics and how load metrics change in response to walking speed modifications. Methods Treadmill walking biomechanics were evaluated in 21 participants with ACLR at three speeds (self-selected (SS); 120% SS and 80% SS). Cumulative loads per step and per kilometer were calculated using knee flexion and adduction moment (KFM and KAM) and vertical ground reaction force (GRF) impulses. Traditional magnitude metrics for KFM, KAM, and GRF were also calculated. Results The ACLR limb displayed smaller KFM and GRF in early and late stances, but larger KFM and GRF during midstance compared with the contralateral limb (P < 0.01). Only GRF cumulative loads (per step and per kilometer) were reduced in the ACLR limb (P < 0.01). In response to speed modifications, load magnitudes generally increased with speed. Conversely, cumulative load metrics (per step and per kilometer) decreased at faster speeds and increased at slow speeds (P < 0.01). Conclusions Patients with ACLR underload their knee in the sagittal plane per step, but cumulatively over the course of many steps/distance, this underloading phenomenon was not apparent. Furthermore, cumulative load increased at slower speeds, opposite to what is identified with traditional single-step metrics. Assessing cumulative load metrics may offer additional insight into how load outcomes may be impacted in injured populations or in response to gait modifications.

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Peak vertical ground reaction force used to identify sub‐groups of individuals with differing biomechanical gait profiles post‐anterior cruciate ligament reconstruction

Collins,

Lisee,

Bjornsen

et al. 2024

Journal Orthopaedic Research

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Lesser peak vertical ground reaction force (vGRF) has been widely reported among individuals with anterior cruciate ligament reconstruction (ACLR). Peak vGRF remains less than uninjured controls and relatively stable during the first year following ACLR. However, it is unknown whether there are subgroups of individuals exhibiting consistently greater peak vGRF in the first 6‐months following ACLR and if individuals with consistently greater peak vGRF exhibit kinematic and kinetic gait differences compared to individuals with low vGRF. The purpose of this study was to determine if distinct clusters exist based upon magnitude of peak vGRF 2‐ and 6‐months post‐ACLR. Subsequently, we explored between cluster differences in vGRF, knee flexion angle, and sagittal and frontal plane knee kinetics throughout stance between clusters. Forty‐three individuals (58.1%female, 21.4 ± 4.4 years‐old, 95.3% patellar‐tendon autograft) completed five gait trials at their habitual walking speed 2‐ and 6‐months post‐ACLR. A single K‐means cluster analysis was used to identify clusters of individuals based on peak vGRF at 2‐ and 6‐months post‐ACLR. Functional waveform analyses were used to compare gait outcomes between clusters with and without controlling for gait speed and age. We identified two clusters that included a subgroup with high vGRF (n = 16) and low vGRF (n = 27). The cluster with high vGRF demonstrated greater vGRFs, knee flexion angles, and knee extension moments during early stance as compared to the low vGRF cluster 2‐ and 6‐months post‐ACLR. Individuals with peak vGRF ≥1.02 times body‐weight 2‐months post‐ACLR had 35.4 times greater odds of being assigned to the high vGRF cluster.

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Worse Tibiofemoral Cartilage Composition Is Associated with Insufficient Gait Kinetics After ACL Reconstruction

Cited by 10 publications

References 49 publications

Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction

Acutely Normalizing Walking Speed Does Not Normalize Gait Biomechanics Post-Anterior Cruciate Ligament Reconstruction

Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics

Peak vertical ground reaction force used to identify sub‐groups of individuals with differing biomechanical gait profiles post‐anterior cruciate ligament reconstruction

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