Bilateral accommodations to anterior cruciate ligament deficiency and surgery
Introduction
Successful locomotion requires a complex interaction between the central nervous system and various muscles to maintain balance, support of the body against gravity, and propel the body forward in a smooth and rhythmical manner (Sadeghi et al., 1997, Sadeghi et al., 2000; Winter et al., 1990). Smooth and rhythmical gait is often associated with gait symmetry while gait asymmetry is commonly associated with gait pathology and injury (Sadeghi et al., 2000). However, while gait symmetry has been reported in the literature (Hamill et al., 1984; Menard et al., 1992), evidence exists suggesting that asymmetrical gait, even in healthy populations, is a common occurrence (Allard et al., 1996; Sadeghi et al., 1997, Sadeghi et al., 2000).
Among the few studies that have investigated bilateral joint accommodations to anterior cruciate ligament (ACL) injury, there is little consistency in the reported results (Berchuck et al., 1990; Ernst et al., 2000; Rudolph et al., 1998; Tibone and Antich, 1993). Tibone and Antich (1993) evaluated 18 ACL deficient patients during walking and reported no significant differences in joint angles or ground reaction force (GRF) variables between limbs. However, Rudolph et al. (1998) reported that the ACL deficient limb exhibited lower peak vertical GRF, a greater knee flexion angle, a reduced knee extensor moment, and reduced knee power absorption compared to the contralateral uninjured limb. In addition, Berchuck et al. (1990) examined chronic ACL deficient subjects during walking and reported a bilateral increase in the hip extensor moment during normal gait as compared to controls. These authors also reported that the ACL injured knee exhibited a sustained flexor moment during midstance compared to the uninjured limb and controls. Thus, the bilateral accommodations that ACL deficient subjects undergo remain unclear and no studies have investigated possible bilateral accommodations following ACL reconstructive surgery.
The contralateral limb is often used for comparison as either a method to determine progression during rehabilitation or as the criteria to determine when the patient is ready to return to full activity. It is possible that bilateral, as well as unilateral joint accommodations could occur as a result of ACL injury and in response to surgical repair (Berchuck et al., 1990; Rudolph et al., 1998; Tibone and Antich, 1993). If so, this information may aid in the rehabilitation of ACL deficient and reconstructed patients. Therefore, the purpose of this investigation was to determine the effect of chronic ACL deficiency and subsequent reconstructive surgery on bilateral lower extremity joint kinematic, moment, and power patterns in chronic ACL deficient subjects prior to and 3 months following surgical repair and in healthy uninjured subjects.
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Participants
Based on a priori power analyses (β=0.20; P=0.05), 20 subjects participated in this investigation. Ten (five males and five females) ACL deficient individuals were compared with 10 (five males and five females) healthy uninjured age and gender-matched control subjects. All subjects were physically active, participating in regular activity at least three times per week. The mean age, body weight, and body height of the ACL deficient subjects were 27.7 (SD 9.1) yr, 79.1 (SD 13.8) kg, and 166.1
Results
There were no differences (P>0.05) in total time of stance between limbs for the control (right: 863.06, SD 77.27 ms; left: 856.93, SD 75.94 ms), ACL deficient (injured: 865.08, SD 52.22 ms; non-injured: 838.97 SD 62.47), and ACL reconstructed (injured: 853.22, SD 72.33 ms; non-injured 858.00 SD 77.39 ms) groups. There were no significant (P>0.05) differences in total time of stance between the three groups. Table 1 presents bilateral knee and hip joint extensor angular impulse, positive work,
Discussion
The purpose of this study was to determine the effect of chronic ACL deficiency and subsequent reconstructive surgery on bilateral lower extremity joint kinematic, moment, and power patterns in chronic ACL deficient subjects prior to and 3 months following surgical repair and in healthy uninjured subjects. Biomechanical adaptations to chronic ACL injury and reconstructive surgery depend on several factors including rehabilitation protocol, patient compliance, and surgical procedure. The present
Conclusions
The present study investigated bilateral symmetry in healthy and chronic ACL injured subjects prior to and 3 months following reconstructive surgery. The control subjects demonstrated asymmetrical hip patterns and symmetrical knee patterns. However, ACL injured subjects exhibited symmetrical hip but asymmetrical knee joint mechanics prior to and following reconstructive surgery. These findings suggest that ACL injury result in joint specific, bilateral lower extremity accommodations and persist
Acknowledgements
This study was supported, in part, by the International Society of Biomechanics Matching Dissertation Grant, the National Athletic Trainers Association Doctoral Research Grant (399-I007), and the Eugene Evonuk Award for Environmental and Stress Physiology. We thank Lisa Meneely and Marc Gori for their assistance with data processing.
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