Gait retraining after anterior cruciate ligament reconstruction 1☆,
Section snippets
Participants
A total of 16 patients (mean age, 27.8±7.4y; weight, 75.5±12.5kg; height, 1.8±0.1m) who had arthroscopically assisted bone-patellar tendon-bone ACL reconstruction and 8 healthy (age, 28.3±4.3y; weight, 71.5±11.1kg; height, 1.7±0.1m) control subjects participated in this study. All subjects with ACL injuries had reconstruction by the same orthopedic surgeon, participated in an accelerated rehabilitation strength and ROM protocol,27 and were restricted from recreational and sporting activities
Group characteristics and protocol adherence
The time from injury to surgery was similar between the 2 ACL reconstruction groups (FDHO group, 120.1±104.5d; range, 5–348d; PSF group, 120.3±107.3d; range, 11–380d). Physical examination revealed all subjects to possess full passive knee extension at both test periods and that body mass did not fluctuate by more than 1kg. Review of the exercise logs demonstrated that all patients complied with the walking program, and that the training load over the 6-week protocol was equal between the 2
Discussion
Numerous studies have found that subjects with ACL reconstruction use neuromuscular adaptations during gait1, 3, 8, 9, 33, 37, 38 and functional activities.1, 10, 11, 35, 39 From these studies, it appears that the hip extensor moments and powers progressively increase during the first 6 months after surgery, whereas the knee extensor moments and powers progressively decrease. In our study, both ACL reconstruction groups showed these classical gait adaptations 6 weeks after surgery. Over the
Conclusions
Gait retraining with the FDHO model showed improvements in lower-extremity positions, hip and knee extensor angular impulse, and work parameters, whereas gait retraining with the PSF showed no statistical improvements. The FDHO mode of training was superior to the PSF protocol in promoting midstance knee ROM and facilitating normal hip extensor function. These gait performance improvements were proposed to stem from an audio signal that accessed locomotor programs and promoted a greater
Acknowledgements
We acknowledge Chris Rich and Mike Kain for their contributions to the data reduction process. We also thank Kevin Shelburne, PhD, for his critical review and contributions to the final manuscript.
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Cited by (35)
Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury
2022, Rheumatic Disease Clinics of North AmericaSubtle alterations in whole body mechanics during gait following anterior cruciate ligament reconstruction
2019, Gait and PostureCitation Excerpt :Self-reported IKDC scores and knee pain during testing suggest that participants were progressing typically [25]. Altered knee mechanics observed in this study are consistent with previous studies [3–7,14]. Participants walked without observable gait alterations, which was supported by an absence of differences in COM position.
Curve analyses reveal altered knee, hip, and trunk kinematics during drop–jumps long after anterior cruciate ligament rupture
2018, KneeCitation Excerpt :A meta-analysis of gait data has also highlighted altered long-term sagittal plane knee mechanics in patients with ACL reconstruction, which might contribute to the early onset or progression of osteoarthritis [45]. Previously, movement retraining programs have been successfully employed to reduce impact forces and increase lower-limb sagittal plane motion during dynamic tasks [44,46], as well as improving knee-specific outcome scores 16 years post-ACLR [47]. Movement retraining should be considered as a valuable tool able to improve knee-specific outcomes and address compensatory movement patterns in ACLR and ACLPT individuals who exhibit long-term alterations in lower extremity mechanics even several decades after an intervention.
Task based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: A clinical commentary
2013, Physical Therapy in SportCitation Excerpt :Seto, Orofino, Morrissey, Medeiros, and Mason (1988) found increased hamstring muscle activation and strength to be associated with superior outcomes (functional scores and return to sport). Abnormal gait patterns have been associated with quadriceps weakness (Bush-Joseph et al., 2001), low patient satisfaction with outcome after ACLR (Kocher et al., 2002), decreased functional performance (Decker, Torry, Noonan, Sterett, & Steadman, 2004), post-operative complications including osteoarthritis (Dye, Staubli, Biedert, & Vaupel, 1999). Patients following ACLR have been shown to have significantly different gait patterns 12 months post-operation (Hall, Stevermer, & Gillette, 2012) with these changes being associated with articular cartilage matrix degeneration (Haughom et al., 2012) and so osteoarthritis risk.
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Supported in part by the NFL Charities and the Steadman-Hawkins Sports Medicine Foundation.
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.