Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

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.

• Authors: Harvi F Hart, Adam G Culvenor, Natalie J Collins, David C Ackland, Sallie M Cowan, Zuzana Machotka, Kay M Crossley
• Journal: British journal of sports medicine (Br J Sports Med) Vol. 50 Issue 10 Pg. 597-612 (May 2016) ISSN: 1473-0480 [Electronic] England
• PMID: 26265562 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: 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/

Topics

• Anterior Cruciate Ligament Injuries (physiopathology, surgery)
• Anterior Cruciate Ligament Reconstruction
• Biomechanical Phenomena (physiology)
• Gait (physiology)
• Humans
• Knee Joint (physiology)
• Postoperative Period