Three-Dimensional Tibiofemoral Kinematics of the Anterior Cruciate Ligament-Deficient and Reconstructed Knee during Walking

Background It is possible that gait abnormalities may play a role in the pathogenesis of meniscal or chondral injury as well as osteoarthritis of the knee in patients with anterior cruciate ligament deficiency. Hypothesis The three-dimensional kinematics of anterior cruciate ligament-deficient knees are changed even during low-stress activities, such as walking, but can be restored by reconstruction. Study Design Case control study. Methods Using a three-dimensional optoelectronic gait analysis system, we examined 13 patients with anterior cruciate ligament-deficient knees, 21 patients with anterior cruciate ligament-reconstructed knees, and 10 control subjects with uninjured knees during walking. Results Normal patterns of knee flexion-extension, abduction-adduction, and internal-external rotation during the gait cycle were maintained by all subjects. A significant difference in tibial rotation angle during the initial swing phase was found in anterior cruciate ligament-deficient knees compared with reconstructed and control knees. The patients with anterior cruciate ligament-deficient knees rotated the tibia internally during the initial swing phase, whereas the others rotated externally. Conclusions Patients with anterior cruciate ligament-deficient knees experienced repeated episodes of rotational instability during walking, whereas patients with reconstruction experienced tibial rotation that is closer to normal. Clinical Relevance Repeated episodes of knee rotational instability may play a role in the development of pathologic knee conditions.