Harvi F Hart1, Adam G Culvenor2, Natalie J Collins3, David C Ackland4, Sallie M Cowan5, Zuzana Machotka6, Kay M Crossley7. 1. Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia Melbourne School of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia. 2. School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia. 3. Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia. 4. Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia. 5. Melbourne School of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia. 6. International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia. 7. School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Abnormal gait after anterior cruciate ligament reconstruction (ACLR) may contribute to development and/or progression of knee osteoarthritis. OBJECTIVE: To conduct a systematic review and meta-analysis of knee kinematics and joint moments during walking after ACLR. METHODS: We searched seven electronic databases and reference lists of relevant papers, for cross-sectional, human-based observational studies comparing knee joint kinematics and moments during level walking in individuals with ACLR, with the uninjured contralateral knee or healthy individuals as a control. Two independent reviewers appraised methodological quality (modified Downs and Black scale). Where possible, data were pooled by time post-ACLR (RevMan), otherwise narrative synthesis was undertaken. RESULTS: Thirty-four studies were included. Meta-analysis revealed significant sagittal plane deficits in ACLR knees. We found greater knee flexion angles (standardised mean difference: 1.06; 95% CI 0.39 to 1.74) and joint moments (1.61; 0.87 to 2.35) <6 months post-ACLR, compared to healthy controls. However, lower peak knee flexion angles were identified 1-3 years (-2.21; -3.16 to -1.26) and ≥3 years post-ACLR (-1.38, -2.14 to -0.62), and lower knee flexion moment 6-12 months post-ACLR (-0.76; -1.40 to -0.12). Pooled data provided strong evidence of no difference in peak knee adduction moment >3 years after ACLR (vs healthy controls) (0.09; -0.63 to 0.81). No transverse plane conclusions could be drawn. CONCLUSIONS: Sagittal plane biomechanics, rather than the knee adduction moment, appear to be more relevant post-ACLR. Better understanding of sagittal plane biomechanics is necessary for optimal post-operative recovery, and to potentially prevent early onset and progression of knee OA after ACLR. TRIAL REGISTRATION NUMBER: PROSPERO systematic review protocol registration number CRD4201400882 2. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND:Abnormal gait after anterior cruciate ligament reconstruction (ACLR) may contribute to development and/or progression of knee osteoarthritis. OBJECTIVE: To conduct a systematic review and meta-analysis of knee kinematics and joint moments during walking after ACLR. METHODS: We searched seven electronic databases and reference lists of relevant papers, for cross-sectional, human-based observational studies comparing knee joint kinematics and moments during level walking in individuals with ACLR, with the uninjured contralateral knee or healthy individuals as a control. Two independent reviewers appraised methodological quality (modified Downs and Black scale). Where possible, data were pooled by time post-ACLR (RevMan), otherwise narrative synthesis was undertaken. RESULTS: Thirty-four studies were included. Meta-analysis revealed significant sagittal plane deficits in ACLR knees. We found greater knee flexion angles (standardised mean difference: 1.06; 95% CI 0.39 to 1.74) and joint moments (1.61; 0.87 to 2.35) <6 months post-ACLR, compared to healthy controls. However, lower peak knee flexion angles were identified 1-3 years (-2.21; -3.16 to -1.26) and ≥3 years post-ACLR (-1.38, -2.14 to -0.62), and lower knee flexion moment 6-12 months post-ACLR (-0.76; -1.40 to -0.12). Pooled data provided strong evidence of no difference in peak knee adduction moment >3 years after ACLR (vs healthy controls) (0.09; -0.63 to 0.81). No transverse plane conclusions could be drawn. CONCLUSIONS: Sagittal plane biomechanics, rather than the knee adduction moment, appear to be more relevant post-ACLR. Better understanding of sagittal plane biomechanics is necessary for optimal post-operative recovery, and to potentially prevent early onset and progression of knee OA after ACLR. TRIAL REGISTRATION NUMBER: PROSPERO systematic review protocol registration number CRD4201400882 2. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Brian Pietrosimone; Richard F Loeser; J Troy Blackburn; Darin A Padua; Matthew S Harkey; Laura E Stanley; Brittney A Luc-Harkey; Veronica Ulici; Stephen W Marshall; Joanne M Jordan; Jeffery T Spang Journal: J Orthop Res Date: 2017-03-02 Impact factor: 3.494
Authors: Luke G Perraton; Michelle Hall; Ross A Clark; Kay M Crossley; Yong-Hao Pua; Tim S Whitehead; Hayden G Morris; Adam G Culvenor; Adam L Bryant Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-11-28 Impact factor: 4.342
Authors: Sandra J Shultz; Randy J Schmitz; Kenneth L Cameron; Kevin R Ford; Dustin R Grooms; Lindsey K Lepley; Gregory D Myer; Brian Pietrosimone Journal: J Athl Train Date: 2019-08-28 Impact factor: 2.860