1994 Nicola Cerulli Young Researchers Award. Downhill walking: a stressful task for the anterior cruciate ligament? A biomechanical study with clinical implications.

Accelerated rehabilitation after anterior cruciate ligament (ACL) reconstruction has become increasingly popular. Methods employed include immediate extension of the knee and immediate full weight bearing despite the risks presented by a graft pull-out fixation strength of 200-500 N. The purpose of this study was to calculate the tibiofemoral shear forces and the dynamic stabilising factors at the knee joint for the reasonably demanding task of downhill walking, in order to determine whether or not this task presented a postoperative risk to the patient. Kinematic and kinetic data were collected on six male and six female healthy subjects during downhill walking on a ramp with a 19% gradient. Planar net joint moments and mechanical power at the knee joint were calculated for the sagittal view using a force platform and videographic records together with standard inverse dynamics procedures. A two-dimensional knee joint model was then utilised to calculate the tibiofemoral shear and compressive forces, based on the predictions of joint reaction force and net moment at the knee. Linear envelopes of the electromyographic (EMG) activity recorded from the rectus femoris, gastrocnemius and biceps femoris muscles were also obtained. The maximum tibiofemoral shear force occurred at 20% of stance phase and was, on average, 1.2 times body weight (BW) for male subjects and 1.7 times BW for female subjects. The tibiofemoral compressive force was 7 times BW for males and 8.5 times BW for females during downhill walking. The hamstring muscle showed almost continuous activity throughout the whole of the stance phase.(ABSTRACT TRUNCATED AT 250 WORDS)