Anteroposterior ground reaction force as an indicator of gait alteration during treadmill walking after anterior cruciate ligament reconstruction

Objectives To identify reported (1) common biomechanical asymmetries in the literature after anterior cruciate ligament (ACL) reconstruction in adolescents during landing and (2) timescales for asymmetry to persist postsurgery. Data Sources We identified sources by searching the CINAHL, PubMed, Scopus, and SPORTDiscus electronic databases using the following search terms: asymmetry OR symmetry AND landing AND biomechanics OR kinematics OR kinetics. Study Selection We screened the titles and abstracts of 85 articles using our inclusion criteria. A total of 13 articles were selected for further analysis. Data Extraction Three reviewers independently assessed the methodologic quality of each study. We extracted the effect sizes directly from studies or calculated them for biomechanical variables assessing asymmetry between limbs of participants with ACL reconstruction. We conducted meta-analyses on variables that were assessed in multiple studies for both double- and single-limb landings. Data Synthesis Asymmetry was more commonly identified in kinetic than kinematic variables. Anterior cruciate ligament reconstruction appeared to have a large effect on asymmetry between limbs for peak vertical ground reaction force, peak knee-extension moment, and loading rate during double-limb landings, as well as mean knee-extension moment and knee energy absorption during both double- and single-limb landings. Conclusions Our findings suggested that return-to-sport criteria after ACL reconstruction should incorporate analysis of the asymmetry in loading experienced by each limb rather than movement patterns alone.

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Longitudinal Kinetic and Kinematic Changes in Functional Tasks After Reconstructing Anterior Cruciate Ligament: A Systematic Review

Journal of Exercise Science and Medicine ◽

10.32598/jesm.12.1.2 ◽

2020 ◽

Vol 12 (1) ◽

pp. 133-146

Author(s):

Fatemeh Sharafoddin-Shirazi ◽

◽

Amir Letafatkar ◽

Zohreh Gholami ◽

◽

...

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Reaction Force ◽

Return To Sports ◽

Cruciate Ligament Reconstruction ◽

Peak Knee ◽

Anterior Cruciate

Introduction: The return to sport after Anterior Cruciate Ligament Reconstruction (ACLR) is among the main issues encountered by rehabilitation medicine, injured athletes, and coaches. A main factor preventing safe return to sports is a biomechanical asymmetry between the limbs during reconstruction, which plays a significant role in the risk of re-injury. Accordingly, injury-related biomechanical changes were systematically examined in individuals with ACLR as performed functional tasks. Materials and Methods: Articles relevant to biomechanical asymmetries between (ACLR & uninjured) limbs in English were searched in the Google Scholar, Science Direct, PubMed MEDLINE, and Scopus databases without time limit until 2021, using the following keywords: “Anterior cruciate ligament reconstruction”, “ACL reconstruction”, “biomechanical”, “Kinetic”, “Kinematic”, and “Asymmetry”. Results: In total, 122 articles were found, of which 18 met the inclusion (PRISMA) criteria. Most of the kinetic and kinematic parameters were observed in the intervals of 3, 6, 9, 12, and 18 months after ACLR between the athletes’ vertical Ground Reaction Force (vGRF), peak hip abduction moment, peak knee valgus angle, peak knee flexion moment and angle, during the functional tasks; also changes were detected in the articles up to 28 months, although research in this area was limited. Conclusion: The present systematic review suggested that biomechanical variables may vary among the limbs of patients with ACLR, between 18 and over 28 months. Accordingly, an asymmetry between the limbs increases the risk of re-injury. Therefore, a better understanding of the biomechanics of the limbs in the time intervals after ACLR can provide a safer and sooner return to sports activities.

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Whole-Body Change-of-Direction Task Execution Asymmetries After Anterior Cruciate Ligament Reconstruction

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0110 ◽

2020 ◽

pp. 1-6

Author(s):

Katherine A.J. Daniels ◽

Eleanor Drake ◽

Enda King ◽

Siobhán Strike

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Center Of Mass ◽

Reaction Force ◽

Whole Body ◽

Cruciate Ligament Reconstruction ◽

Heading Angle ◽

Anterior Cruciate

Cutting maneuvers can be executed at a range of angles and speeds, and these whole-body task descriptors are closely associated with lower-limb mechanical loading. Asymmetries in angle and speed when changing direction off the operated and nonoperated limbs after anterior cruciate ligament reconstruction may therefore influence the interpretation of interlimb differences in joint-level biomechanical parameters. The authors hypothesized that athletes would reduce center-of-mass heading angle deflection and body rotation during the change-of-direction stance phase when cutting from the operated limb, and would compensate for this by orienting their center-of-mass trajectory more toward the new intended direction of travel prior to touchdown. A total of 144 male athletes 8 to 10 months after anterior cruciate ligament reconstruction performed a maximum-effort sidestep cutting maneuver while kinematic, kinetic, and ground reaction force data were recorded. Peak ground reaction force and knee joint moments were lower when cutting from the operated limb. Center-of-mass heading angle deflection during stance phase was reduced for cuts performed from the operated limb and was negatively correlated with heading angle at touchdown. Between-limb differences in body orientation and horizontal velocity at touchdown were also observed. These systematic asymmetries in cut execution may require consideration when interpreting joint-level interlimb asymmetries after anterior cruciate ligament reconstruction and are suggestive of the use of anticipatory control to co-optimize task achievement and mechanical loading.

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