All-inside ACL: retroconstruction controversies.

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Abstract

[Indexed for MEDLINE] 17. Med Sci Sports Exerc. 2022 May 1;54(5):709-716. doi: 10.1249/MSS.0000000000002860. Epub 2022 Jan 24. Linking Gait Biomechanics and Daily Steps After ACL Reconstruction. Lisee C(1), Davis-Wilson HC(2), Evans-Pickett A, Horton WZ(3), Blackburn JT, Franz JR(4), Thoma LM(5), Spang JT(6), Pietrosimone BG. Author information: (1)MOTION Science Institute, Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC. (2)Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO. (3)Department of Statistics, University of California Santa Cruz, Santa Cruz, CA. (4)Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC. (5)Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC. (6)Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC. PURPOSE: Aberrant biomechanics and altered loading frequency are associated with poor knee joint health in osteoarthritis development. After anterior cruciate ligament reconstruction (ACLR), individuals demonstrate underloading (lesser vertical ground reaction force (vGRF)) with stiffened knee gait biomechanics (lesser knee extension moment (KEM) and knee flexion angle) and take fewer daily steps as early as 6 months after surgery. The purpose of this cross-sectional laboratory study is to compare gait biomechanics throughout stance between individuals 6-12 months after ACLR who take the lowest, moderate, and highest daily steps. METHODS: Individuals with primary, unilateral history of ACLR between the ages of 16 and 35 yr were included (n = 36, 47% females; age, 21 ± 5 yr; months since ACLR, 8 ± 2). Barefoot gait biomechanics of vGRF (body weight), KEM (body weight × height), and knee flexion angle during stance were collected and time normalized. Average daily steps were collected via a waist-mounted accelerometer in free-living settings over 7 d. Participants were separated into tertiles based on lowest daily steps (3326-6042 daily steps), moderate (6043-8198 daily steps), and highest (8199-12,680 daily steps). Biomechanical outcomes of the ACLR limb during stance were compared between daily step groups using functional waveform gait analyses. RESULTS: There were no significant differences in sex, body mass index, age, or gait speed between daily step groups. Individuals with the lowest daily steps walk with lesser vGRF and lesser KEM during weight acceptance, and lesser knee flexion angle throughout stance in the ACLR limb compared with individuals with highest and moderate daily steps. CONCLUSIONS: After ACLR, individuals who take the fewest daily steps also walk with lesser vGRF during weight acceptance and a stiffened knee strategy throughout stance. These results highlight complex interactions between joint loading parameters after ACLR. Copyright © 2022 by the American College of Sports Medicine. DOI: 10.1249/MSS.0000000000002860 PMCID: PMC9255696