Gait Characteristics of People with Lateral Knee Osteoarthritis after ACL Reconstruction.

PURPOSE Lateral knee osteoarthritis (OA) is common after anterior cruciate ligament reconstruction (ACLR), yet gait characteristics associated with lateral knee OA after ACLR are not well understood. This cross-sectional study aimed to compare knee, trunk, pelvis, hip, and ankle kinematics and moments between people with predominant lateral knee OA after ACLR and healthy controls. METHODS Nineteen post-ACLR people with lateral knee OA and 25 healthy controls were recruited. Quantitative gait analysis was conducted during walking, and knee pain, confidence, and kinesiophobia were assessed. Between-group differences in peak kinematics and moments were evaluated, and Pearson correlations evaluated relations between biomechanical and patient-reported measures (P < 0.05). RESULTS Participants with lateral knee OA after ACLR had greater peak knee flexion (mean difference, 3.5°; 95% confidence interval, 0.9-6.1) and lower knee internal rotation angles (-3.3°; -6.2 to -0.5) than the controls. Those with lateral knee OA also had greater peak pelvic anterior tilt (3.1°, 0.4-5.9), hip flexion angles (5.1°, 1.9-8.3), and peak ankle dorsiflexion moment (0.1 N·m·kg(-1), 0.0-0.2). In the lateral knee OA group, worse knee confidence and kinesiophobia were significantly correlated with greater peak trunk flexion angle (r = 0.654 and r = 0.535, respectively) and greater knee pain was significantly correlated with greater peak knee flexion angle (r = 0.535). CONCLUSIONS Gait characteristics associated with lateral knee OA after ACLR differ from those in healthy individuals, predominantly in the sagittal plane. Increased sagittal plane knee and trunk kinematics seem to be related to worse knee pain, confidence, and kinesiophobia. These findings will assist the development of compartment-specific interventions for individuals with posttraumatic lateral knee OA.

[1]  E. Roos,et al.  Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. , 2003, Arthritis and rheumatism.

[2]  M. Torry,et al.  Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. , 2000, Clinical biomechanics.

[3]  Anthony G Schache,et al.  On the expression of joint moments during gait. , 2007, Gait & posture.

[4]  Anthony G Schache,et al.  Patellofemoral joint loading during stair ambulation in people with patellofemoral osteoarthritis. , 2013, Arthritis and rheumatism.

[5]  T. Andriacchi,et al.  Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. , 2005, Arthritis and rheumatism.

[6]  Anthony G Schache,et al.  Defining the knee joint flexion-extension axis for purposes of quantitative gait analysis: an evaluation of methods. , 2006, Gait & posture.

[7]  N. Zheng,et al.  Alterations in three-dimensional joint kinematics of anterior cruciate ligament-deficient and -reconstructed knees during walking. , 2010, Clinical biomechanics.

[8]  Marcus G Pandy,et al.  Muscle coordination of mediolateral balance in normal walking. , 2010, Journal of biomechanics.

[9]  A. Wolf,et al.  Six‐week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis , 2014, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  Thomas P Andriacchi,et al.  Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees. , 2010, Journal of biomechanics.

[11]  Marcus G Pandy,et al.  Trunk muscle action compensates for reduced quadriceps force during walking after total knee arthroplasty. , 2013, Gait & posture.

[12]  R. D'ambrosia,et al.  The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability , 1987, The American journal of sports medicine.

[13]  J. Hart,et al.  Neuromuscular consequences of anterior cruciate ligament injury. , 2008, Clinics in sports medicine.

[14]  M. Pandy,et al.  Are Knee Biomechanics Different in Those With and Without Patellofemoral Osteoarthritis After Anterior Cruciate Ligament Reconstruction? , 2014, Arthritis care & research.

[15]  K. Crossley,et al.  Is impaired knee confidence related to worse kinesiophobia, symptoms, and physical function in people with knee osteoarthritis after anterior cruciate ligament reconstruction? , 2015, Journal of science and medicine in sport.

[16]  T. Vail,et al.  A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. , 2005, Arthritis and rheumatism.

[17]  T. Theologis,et al.  Prediction of the hip joint centre in adults, children, and patients with cerebral palsy based on magnetic resonance imaging. , 2007, Journal of biomechanics.

[18]  David T Felson,et al.  High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects. , 2002, Arthritis and rheumatism.

[19]  M. Englund,et al.  High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. , 2004, Arthritis and rheumatism.

[20]  C. Cooper,et al.  Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. , 1992, Annals of the rheumatic diseases.

[21]  Matthew R. Patterson,et al.  Peak knee adduction moment during gait in anterior cruciate ligament reconstructed females. , 2014, Clinical biomechanics.

[22]  E. Roos,et al.  Joint injury causes knee osteoarthritis in young adults , 2005, Current opinion in rheumatology.

[23]  R. Hinman,et al.  Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics. , 2012, Clinical biomechanics.

[24]  L. Salmon,et al.  The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture. , 2012, The Journal of bone and joint surgery. British volume.

[25]  E. Roos,et al.  The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries , 2007, The American journal of sports medicine.

[26]  G. Gold,et al.  Atlas of individual radiographic features in osteoarthritis, revised. , 2007, Osteoarthritis and cartilage.

[27]  P. Onghena,et al.  Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance , 1995, Pain.

[28]  L. Sharma,et al.  Knee confidence as it relates to physical function outcome in persons with or at high risk of knee osteoarthritis in the osteoarthritis initiative. , 2012, Arthritis and rheumatism.

[29]  T. Andriacchi,et al.  Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. , 1998, Arthritis and rheumatism.

[30]  L. Engebretsen,et al.  The association between radiographic knee osteoarthritis and knee symptoms, function, and quality of life 10-15 years after anterior cruciate ligament reconstruction , 2012 .

[31]  M. R. Pierrynowski.  Gait mechanics after ACL reconstruction: implications for the early onset of knee osteoarthritis , 2010 .

[32]  T. Andriacchi,et al.  Interaction between active and passive knee stabilizers during level walking , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[33]  F. Cicuttini,et al.  Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis , 2011, Annals of the rheumatic diseases.

[34]  Robert J. Butler,et al.  Frontal-Plane Gait Mechanics in People With Medial Knee Osteoarthritis Are Different From Those in People With Lateral Knee Osteoarthritis , 2011, Physical Therapy.

[35]  Johan Kärrholm,et al.  Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: Gait analysis of 30 patients and 15 controls , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[36]  Thomas P Andriacchi,et al.  Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. , 2008, Medicine and science in sports and exercise.

[37]  J. Ahn,et al.  Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[38]  K. Webster,et al.  The knee adduction moment in hamstring and patellar tendon anterior cruciate ligament reconstructed knees , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[39]  K. Webster,et al.  Longitudinal changes in knee joint biomechanics during level walking following anterior cruciate ligament reconstruction surgery. , 2012, Gait & posture.