Evaluation of gait kinematics and symmetry during the first two stages of physiotherapy after anterior cruciate ligament reconstruction (original) (raw)
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BMC Musculoskeletal Disorders, 2015
Background: The goal of this study was to biomechanically assess tibial rotation in the knee joint simultaneous changes in rotation of large joints of the lower limbs and pelvis during gait in patients during early postoperative stages following anterior cruciate ligament (ACLR) reconstruction. We hypothesized that tibial rotation is associated with changes in rotation of the large joints of the lower limbs and the pelvis during gait in patients after ACLR reconstruction. Methods: The patients were divided into two groups. The ACLR group (n = 32 males) underwent primary ACLR in one leg and postoperative physiotherapy. The control group (n = 30 males) had no knee injuries. After clinical assessment in both groups, the values of kinematic parameters of foot, tibial, femoral, and pelvic rotation were measured during gait on a flat surface using the three-dimensional BTS Smart System. In the ACLR group, measurements were taken during the 4th, 9th, and 14th weeks of postoperative physiotherapy. The results of the ACLR group were compared with those of the control group. Results: During gait, between the 9th and 14th weeks following ACLR, there are normal values of foot, tibia, and pelvic rotation in the operated legs compared with results obtained from un-operated legs and the control group. Discussion: Analysis of rotations occurring only in knee joints does not reflect all of the multiarticular disorders of gait kinematics. The study also suggests that analyzing tibial rotation in the knee joint with simultaneous changes in rotation in large joints of the lower limbs provides better opportunities than singular analysis of rotation in the knee joint for the assessment of disorders in gait kinematics. Conclusions: In gait, at the maximal extension of the knee during preparation for the stance phase, external hip rotation patterns have not been fully restored 14 weeks after ACLR.
Gait Asymmetries Persist 1 Year After Anterior Cruciate Ligament Reconstruction
Orthopaedic journal of sports medicine, 2013
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. 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. Prospective analysis. 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 d...
DEVITA. P.. T. HORTOBAGYI, and I. BARRIER. Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation. . Purpose: Accelerated rehabilitation for anterior cruciate ligament (ACL) injury and reconstruction surgery is designed to return injured people to athletic activities in approximately 6 months. The small amount of empirical data on this population suggests, however, that the torque at the knee joint may not return until 29, months after surgery during walking and even longer during running. Although the rehabilitation has ended and individuals have returned to preinjury activities. gait mechanics appear to be abnormal at the end of accelerated programs. The purpose of this study was to compare lower extremity joint kinematics. kinetics, and energetics between individuals having undergone ACL reconstruction and accelerated rehabilitation and healthy individuals. Methods: Eight ACL-injured and 22 healthy subjects were tested. Injured subjects were tested 3 wk and 6 months (the end of rehabilitation) rfter surgery. Ground reaction force and kinematic data were combined with inverse dynamics to predict snginal plane joint toques and powers from which angular impulse and work were derived. Results: The difference in all kinematic variables between the two tests for the ACL group avenged 38% (all P < 0.05 ).
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose-The aims of this study were to evaluate the functional recovery before and after ACL reconstruction and to evaluate the sensitivity to change in performance-based and self-report outcomes prior to and after ACL reconstruction and to determine if these changes represent clinically relevant improvement. Methods-Eighty-three athletes participated in this study. Athletes were tested after an ACL injury, after pre-operative training, and 6 and 12 months after ACL reconstruction. Athletes completed quadriceps strength testing, hop testing, and self-reported questionnaires for knee function (International Knee Documentation Committee subjective knee form, Knee Outcome Survey-Activities of Daily Living Scale, and the Global Rating Scale of Perceived Function) at each testing period. Results-A significant interaction of limb by time was seen in normalized quadriceps strength, and single, triple, and 6-meter timed hop, where the involved limb improved more than the uninvolved limb over time. A main effect of time was noted for performance-based limb symmetry indexes and self-report measures. Conclusion-Limb-to-limb asymmetries are reduced and normal limb symmetry is restored after perturbation training and aggressive quadriceps strengthening and returned to similar levels 6 months after reconstruction. Performance-based values on the involved limb and self-reported outcomes are sensitive to change over time and these were clinically relevant improvements.
Lower limb symmetry index (LLSI) pre- and post-reconstruction of the ACL: a controlled study
Manual Therapy, Posturology & Rehabilitation Journal, 2018
Background: The anterior cruciate ligament (ACL) lesion causes a deficit in joint stability and mobility, trophism and muscular strength, generating asymmetries between the lower limbs. Objective: To verify the effect of a physiotherapeutic protocol on the Lower Limb Symmetry Index (LLSI) and the correlation between strength and EMGs, pre and post reconstruction of the ACL. Methods: Twenty subjects (10 ACLrg + 10 CONTg) were evaluated regarding isometric force and electrical activity of knee extensors, knee flexors and hip abductors. Results: A significant increase (P<0.01) in knee extension and flexion strength and hip abduction strength were observed both for the affected limb and non-affected limb. Regarding the LLSI, a significant increase was observed for knee extension and hip abduction movements in the pre-and post-treatment comparison, and between ACLrg X CONTg (P<0.01) for the knee extension movement in the pre-reconstruction phase of the ACL. A very strong correlation (r=0.945; P<0.01) was also observed between the LLSI strength X EMGs during knee extension, pre-and post-reconstruction surgery. Conclusions: Six months after reconstruction of the ACL, there was an increase in strength and EMG activity of the knee flexor, knee extensor and hip abductor muscles, leveling the LLSI between ACLrg and the CONTg, however, with a significant correlation between the two variables (strength X EMGs) for only one of the three movements (knee extension).
Limb asymmetry during recovery from anterior cruciate ligament reconstruction
Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 2018
There is limited literature that follows a population of Anterior Cruciate Ligament Reconstruction (ACLR) patients through recovery. Our aim was to examine differences in movement and loading patterns across time and between limbs over four visits during 12 months post-ACLR. We hypothesized that kinematic and kinetic data during a stop-jump would have time- and limb-dependent differences through 12 months post-surgery. Twenty-three ACLR athletes performed five vertical stop-jumps at 4, 5, 6, and 12 months post-op with motion capture and force plate data collection. The peak knee flexion (PKF) was different between the 4 and 12, 5 and 6, and the 5 and 12 month visits with earlier months exhibiting higher PKF. The peak vertical ground reaction force (vGRF) was lower at 4 than at 5 and 6 months. The peak posterior ground reaction force (pGRF) was lower at 4 months than all other visits. Frontal knee and sagittal hip range of motion (ROM) were different between 12 months and each previo...
Applied Sciences, 2020
The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p<0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p<0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the op...