Whether Patients with Anterior Cruciate Ligament Reconstruction Walking at a Fast Speed Show more Kinematic Asymmetries?

Abstract

Objective: Knee kinematic asymmetries after anterior cruciate ligament reconstruction (ACLR) are correlated with poor clinical outcomes, such as the progression of knee cartilage degenerations or reinjuries. Fast walking in patients with knee conditions may exacerbate knee kinematic asymmetries, but its impact on ACLR patients is uncertain. The aim of this study is to investigate if fast walking induces more knee kinematic asymmetries in unilateral ACLR patients.

Methods: This cross-sectional study enrolled 55 patients with unilateral ACLR from January 2020 to July 2022. There were 48 males and seven females with an average age of 30.6 ± 6.4 years. Knee kinematic data were collected at three walking speeds: self-selected, fast (150% normal), and slow (50% normal). A 3D knee kinematic analysis system measured the data, and self-reported outcomes assessed comfort levels during walking. We used SPM1D for two-way repeated ANOVA and posthoc paired t-tests to analyze kinematic differences in groups.

Results: In fast walking, ACLR knees exhibited more transverse kinematic asymmetries than intact knees, including greater external rotation angle (1.8°, 38%–43%; gait cycle [GC], p < 0.05 & 1.8–2.7°, 50%–61% GC, p < 0.05) and increased proximal tibial translation (2.1–2.5 mm, 2%–6% GC, p < 0.05 & 2.5–3.2 mm, 92%–96% GC, p < 0.05). Additionally, ACLR knees showed greater posterior tibial translation than intact knees (3.6–3.7 mm, 7%–8% GC, p < 0.05) during fast walking. No posterior tibial translation asymmetries were observed in slow walking compared to normal walking levels. ACLR knees have the most comfortable feelings in slow walking speed, and the most uncomfortable feelings in fast walking speed levels (29%).

Conclusions: Fast walking induces additional external tibial rotation and proximal and posterior tibial translation asymmetries in ACLR patients. This raises concerns about long-term safety and health during fast walking. Fast walking, not self-selected speed, is beneficial for identifying postoperative gait asymmetries in ACLR patients.

Keywords

ACLR / Gait / Kinematic Asymmetries / Walking Speed

References

[1] FilbaySR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33:33–47.

[2] GriffinLY, AlbohmMJ, ArendtEA, Bahr R, BeynnonBD, DeMaioM, et al. Understanding and preventing noncontact anterior cruciate ligament injuries. Am J Sports Med. 2006;34:1512–1532.

[3] WangL, ZengN, YanZ, LiJ, NiG. Post-traumatic osteoarthritis following ACL injury. Arthritis Res Ther. 2020;22:57.

[4] DareD, RodeoS. Mechanisms of post-traumatic osteoarthritis after ACL injury. Curr Rheumatol Rep. 2014;16:448.

[5] KaurM, Ribeiro DC, TheisJ, WebsterKE, SoleG. Movement patterns of the knee during gait following ACL reconstruction: a systematic review and meta-analysis. Sports Med. 2016;46:1869–1895.

[6] MantashlooZ, Letafatkar A, MoradiM. Vertical ground reaction force and knee muscle activation asymmetries in patients with ACL reconstruction compared to healthy individuals. Knee Surg Sports Traumatol Arthrosc. 2020;28:2009–2014.

[7] ArhosEK, CapinJJ, BuchananTS, Snyder-Mackler L. Quadriceps strength symmetry does not modify gait mechanics after anterior cruciate ligament reconstruction, rehabilitation, and return-to-sport training. Am J Sports Med. 2021;49:417–425.

[8] FukuchiCA, Fukuchi RK, DuarteM. Effects of walking speed on gait biomechanics in healthy participants: a systematic review and meta-analysis. Syst Rev. 2019;8:153.

[9] Nazary-MoghadamS, Salavati M, EstekiA, AkhbariB, Keyhani S, ZeinalzadehA. Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency. Knee. 2019;26:88–96.

[10] KnobelRJ, ItoN, ArhosEK, Capin JJ, BuchananTS, Snyder-MacklerL. Patients walking faster after anterior cruciate ligament reconstruction have more gait asymmetry. Int J Sports Phys Ther. 2021;16:169–176.

[11] GarciaSA, BrownSR, KojeM, Krishnan C, Palmieri-SmithRM. Gait asymmetries are exacerbated at faster walking speeds in individuals with acute anterior cruciate ligament reconstruction. J Orthop Res. 2022;40:219–230.

[12] KongL, YangT, WangQ, Ou Y, HuangH, HuangW, et al. ACLD patients exhibit additional knee kinematic asymmetries at the speed level of healthy subjects. Front Bioeng Biotechnol. 2022;10:930722.

[13] PurserJL, Golightly YM, FengQ, HelmickCG, RennerJB, JordanJM. Association of slower walking speed with incident knee osteoarthritis–related outcomes. Arthritis Care Res. 2010;2012(64):1028–1035.

[14] PietrosimoneB, Troy Blackburn J, HarkeyMS, LucBA, Hackney AC, PaduaDA, et al. Walking speed As a potential indicator of cartilage breakdown following anterior cruciate ligament reconstruction. Arthritis Care Res (Hoboken). 2016;68:793–800.

[15] ZhangY, YaoZ, WangS, Huang W, MaL, HuangH, et al. Motion analysis of Chinese normal knees during gait based on a novel portable system. Gait Posture. 2015;41:763–768.

[16] ElfringR, de la Fuente M, RadermacherK. Assessment of optical localizer accuracy for computer aided surgery systems. Comput Aided Surg. 2010;15:1–12.

[17] ZhangY, HuangW, YaoZ, MaL, LinZ, WangS, et al. Anterior cruciate ligament injuries Alter the kinematics of knees with or without meniscal deficiency. Am J Sports Med. 2016;44:3132–3139.

[18] PatakyTC. One-dimensional statistical parametric mapping in python. Comput Methods Biomech Biomed Engin. 2012;15:295–301.

[19] ZabalaME, FavreJ, AndriacchiTP. Relationship between knee mechanics and time since injury in ACL-deficient knees without signs of osteoarthritis. Am J Sports Med. 2015;43:1189–1196.

[20] ChenC, LiJ, HosseiniA, Gadikota HR, GillTJ, LiG. Anteroposterior stability of the knee during the stance phase of gait after anterior cruciate ligament deficiency. Gait Posture. 2012;35:467–471.

[21] ZaidM, Lansdown D, SuF, PedoiaV, TuftsL, RizzoS, et al. Abnormal tibial position is correlated to early degenerative changes one year following ACL reconstruction. J Orthop Res. 2015;33:1079–1086.

[22] KiapourAM, Fleming BC, MurrayMM. Structural and anatomic restoration of the anterior cruciate ligament is associated with less cartilage damage 1 year after surgery: healing ligament properties affect cartilage damage. Orthop J Sports Med. 2017;5:1808771310.

[23] IkutaF, YonetaK, MiyajiT, Kidera K, YonekuraA, OsakiM, et al. Knee kinematics of severe medial knee osteoarthritis showed tibial posterior translation and external rotation: a cross-sectional study. Aging Clin Exp Res. 2020;32:1767–1775.

[24] LiAK, OchoaJK, PedoiaV, Amano K, SouzaRB, LiX, et al. Altered tibiofemoral position following ACL reconstruction is associated with cartilage matrix changes: a voxel-based relaxometry analysis. J Orthop Res. 2020;38:2454–2463.

[25] ShiH, RenS, HuangH, Liu H, LiangZ, YuY, et al. Bilateral alterations in isokinetic strength and knee biomechanics during side-cutting 1 year after unilateral ACL reconstruction. Am J Sports Med. 2022;50:2961–2971.

[26] YangT, HuangY, ZhongG, Kong L, YanY, LaiH, et al. 6DOF knee kinematic alterations due to increased load levels. Front Bioeng Biotechnol. 2022;10:927459.

[27] MurakiS, AkuneT, En-yoY, Yoshida M, SuzukiT, YoshidaH, et al. Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1). Osteoarthr Cartil. 2015;23:874–881.

[28] ShabaniB, BytyqiD, LustigS, Cheze L, BytyqiC, NeyretP. Gait knee kinematics after ACL reconstruction: 3D assessment. Int Orthop. 2015;39:1187–1193.

[29] FreiwaldJ, JagerA, StarkerM. EMG-assisted functional analysis within the scope of follow-up of arthroscopically managed injuries of the anterior cruciate ligament. Sportverletz Sportschaden. 1993;7:122–128.

[30] PeeblesAT, Williams BR, QueenRM. Bilateral squatting mechanics are associated with landing mechanics in anterior cruciate ligament reconstruction patients. Am J Sports Med. 2021;49:2638–2644.

[31] ZengZ, ShanJ, ZhangY, Wang Y, LiC, LiJ, et al. Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis. Front Bioeng Biotechnol. 2022;10:922832.

[32] EllisonTM, Flagstaff I, JohnsonAE. Sexual dimorphisms in anterior cruciate ligament injury: a current concepts review. Orthop J Sports Med. 2021;9:941630360.

[33] PaternoMV, Schmitt LC, FordKR, RauhMJ, MyerGD, HuangB, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38:1968–1978.

RIGHTS & PERMISSIONS

2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.