Kanto Nagai1,2, Tom Gale1, Elmar Herbst1,3, Yasutaka Tashiro1, James J Irrgang1, Scott Tashman1, Freddie H Fu4, William Anderst1. 1. Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. 2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 3. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany. 4. Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. ffu@upmc.edu.
Abstract
PURPOSE: To evaluate the effect of knee hyperextension on dynamic in vivo kinematics after anterior cruciate ligament reconstruction (ACL-R). METHODS: Forty-two patients underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking and downhill running on a treadmill while dynamic stereo radiographs were acquired at 100 (walking) and 150 Hz (running). Tibiofemoral motion was determined using a validated model-based tracking process, and tibiofemoral translations/rotations were calculated. The range of tibiofemoral motions from 0 to 10% of the gait cycle (heel strike to early stance phase) and side-to-side difference (SSD) were calculated. Maximum knee extension angle of ACL-reconstructed knees during walking was defined as active knee extension angle in each subject. Correlations between maximum knee extension angle and tibiofemoral kinematics data were evaluated using Spearman's rho (P < 0.05). RESULTS: No significant correlation was observed between maximum knee extension angle and the range of anterior tibial translation during functional activities in the ACL-R knees. Maximum knee extension angle was weakly correlated with internal tibial rotation range in ACL-R knee during running (ρ = 0.376, P = 0.014); however, maximum extension angle was not correlated with SSD of internal tibial rotation. SSD of internal tibial rotation was -0.4° ± 1.9° (walking), -1.6° ± 3.1° (running), indicating ACL-R restored rotatory knee range of motion during functional movements. CONCLUSION:Knee hyperextension was not significantly correlated with greater SSD of anterior translation and internal rotation. The clinical relevance is that knee hyperextension does not adversely affect kinematic outcomes after ACL-R and that physiologic knee hyperextension can be restored after ACL-R when knee hyperextension is present. LEVEL OF EVIDENCE: III.
RCT Entities:
PURPOSE: To evaluate the effect of knee hyperextension on dynamic in vivo kinematics after anterior cruciate ligament reconstruction (ACL-R). METHODS: Forty-two patients underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking and downhill running on a treadmill while dynamic stereo radiographs were acquired at 100 (walking) and 150 Hz (running). Tibiofemoral motion was determined using a validated model-based tracking process, and tibiofemoral translations/rotations were calculated. The range of tibiofemoral motions from 0 to 10% of the gait cycle (heel strike to early stance phase) and side-to-side difference (SSD) were calculated. Maximum knee extension angle of ACL-reconstructed knees during walking was defined as active knee extension angle in each subject. Correlations between maximum knee extension angle and tibiofemoral kinematics data were evaluated using Spearman's rho (P < 0.05). RESULTS: No significant correlation was observed between maximum knee extension angle and the range of anterior tibial translation during functional activities in the ACL-R knees. Maximum knee extension angle was weakly correlated with internal tibial rotation range in ACL-R knee during running (ρ = 0.376, P = 0.014); however, maximum extension angle was not correlated with SSD of internal tibial rotation. SSD of internal tibial rotation was -0.4° ± 1.9° (walking), -1.6° ± 3.1° (running), indicating ACL-R restored rotatory knee range of motion during functional movements. CONCLUSION:Knee hyperextension was not significantly correlated with greater SSD of anterior translation and internal rotation. The clinical relevance is that knee hyperextension does not adversely affect kinematic outcomes after ACL-R and that physiologic knee hyperextension can be restored after ACL-R when knee hyperextension is present. LEVEL OF EVIDENCE: III.
Authors: Paulo H Araujo; Carola F van Eck; Jeffrey A Macalena; Freddie H Fu Journal: Knee Surg Sports Traumatol Arthrosc Date: 2011-02-11 Impact factor: 4.342