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Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction.

White K, Logerstedt D, Snyder-Mackler L - Orthop J Sports Med (2013)

Bottom Line: Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs.Early return to activity did not ensure limb symmetry at 1 year.Potentially prolonging athlete's timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function.

View Article: PubMed Central - HTML - PubMed

Affiliation: Investigation performed at the Physical Therapy Department, University of Delaware, Newark, Delaware, USA.

ABSTRACT

Background: After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery.

Purpose: To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail.

Study design: Prospective analysis.

Methods: A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects.

Results: There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs.

Conclusion: Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year.

Clinical relevance: Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging athlete's timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function.

No MeSH data available.


Related in: MedlinePlus

Knee flexion angle during stance.
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Figure 1: Knee flexion angle during stance.

Mentions: There was no significant limb × group interaction (P > .13) and no effect of group (P > .054) for all kinematic and kinetic measures. There was a main effect of limb for knee flexion angles at PKF (P=.02) and PKE (P=.01)(Table 4). Knee flexion angles at PKF were smaller on the involved limb compared with the uninvolved limb in both groups (pass, P = .16; fail, P = .07). The involved limb of all subjects was more flexed at PKE compared with the uninvolved limb (pass, P = .10; fail, P = .051); however, differences between limbs did not exceed MCID at both PKF and PKE (Table 4, Figure 1).


Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction.

White K, Logerstedt D, Snyder-Mackler L - Orthop J Sports Med (2013)

Knee flexion angle during stance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4326084&req=5

Figure 1: Knee flexion angle during stance.
Mentions: There was no significant limb × group interaction (P > .13) and no effect of group (P > .054) for all kinematic and kinetic measures. There was a main effect of limb for knee flexion angles at PKF (P=.02) and PKE (P=.01)(Table 4). Knee flexion angles at PKF were smaller on the involved limb compared with the uninvolved limb in both groups (pass, P = .16; fail, P = .07). The involved limb of all subjects was more flexed at PKE compared with the uninvolved limb (pass, P = .10; fail, P = .051); however, differences between limbs did not exceed MCID at both PKF and PKE (Table 4, Figure 1).

Bottom Line: Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs.Early return to activity did not ensure limb symmetry at 1 year.Potentially prolonging athlete's timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function.

View Article: PubMed Central - HTML - PubMed

Affiliation: Investigation performed at the Physical Therapy Department, University of Delaware, Newark, Delaware, USA.

ABSTRACT

Background: After anterior cruciate ligament reconstruction (ACLR), motivation to return to previous levels of activity is high. Very few studies have used return-to-activity criteria to determine when to permit athletic play. Return-to-activity measures objectively evaluate functional limb symmetry; however, previous biomechanical studies have found gait deviations in these individuals that persist up to 2 years after surgery.

Purpose: To evaluate gait biomechanics in a specific cohort of ACL patients 1 year after surgery and retrospectively compare individuals who pass return-to-activity criteria 6 months after surgery with those who fail.

Study design: Prospective analysis.

Methods: A total of 40 athletes who participated regularly (>50 h/y) in cutting, jumping, and pivoting activities and who sustained an isolated, unilateral ACL rupture were included in this study. All participants underwent reconstruction by the same surgeon and received individualized postoperative rehabilitation. Performance-based and self-report data were measured 6 months after surgery to assess readiness to return to activity (90% outcome required to pass); 20 subjects passed return-to-activity criteria and 20 subjects did not. Motion analysis was performed 1 year after surgery, and knee flexion angles, moments, and excursions were measured during gait and evaluated for all subjects.

Results: There was no limb × group interaction or effect of group for all measures. Decreased knee measures were seen on the involved limb compared with the uninvolved limb for all subjects, and failed subjects demonstrated larger differences between limbs.

Conclusion: Patients continued to demonstrate biomechanical limb asymmetries 1 year after ACLR, regardless of performance-based measures at 6 months. Early return to activity did not ensure limb symmetry at 1 year.

Clinical relevance: Gait asymmetries were seen in all subjects 1 year after surgery regardless of status at 6 months. Potentially prolonging athlete's timelines for returning to activity may prove beneficial for a successful return to activity as well as for long-term knee function.

No MeSH data available.


Related in: MedlinePlus