Elsevier

Clinical Biomechanics

Volume 19, Issue 2, February 2004, Pages 136-144
Clinical Biomechanics

Bilateral accommodations to anterior cruciate ligament deficiency and surgery

https://doi.org/10.1016/j.clinbiomech.2003.10.008Get rights and content

Abstract

Objective. To determine bilateral lower extremity joint accommodations during gait in anterior cruciate ligament deficient subjects and uninjured controls.

Design. Gait testing of 10 chronic anterior cruciate ligament deficient subjects prior to and 3 months following reconstructive surgery, and 10 uninjured controls.

Background. It is possible that bilateral joint accommodations could occur as a result of anterior cruciate ligament injury and in response to surgical repair. Few studies have investigated bilateral joint accommodations to anterior cruciate ligament injury and there is little consistency in the reported results.

Methods. Bilateral lower extremity kinematic and kinetic data were collected from 12 walking trials and inverse dynamics calculations were made to estimate bilateral knee and hip joint angle, moment, and power patterns during the stance phase of gait.

Results. Control subjects exhibited asymmetrical hip but symmetrical knee joint moment and power patterns. In contrast, the anterior cruciate ligament deficient subjects exhibited symmetrical hip and asymmetrical knee joint moment and power patterns prior to and following reconstructive surgery.

Conclusions. Gait asymmetry in healthy subjects should not be considered pathological. In addition, chronic anterior cruciate ligament injury results in joint specific, bilateral lower extremity accommodations in gait mechanics. These accommodations persist 3 months following surgical repair.
Relevance

Often times, the contralateral, non-injured limb is used as the clinical criteria for rehabilitation progression and return to full activity. However, gait adaptations to the contralateral limb following chronic deficiency and surgery remain unclear. This information may aid in the rehabilitation of anterior cruciate ligament injured and reconstructed patients.

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.

Section snippets

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.

References (20)

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