Program in Human Movement Science, University of North Carolina at Chapel Hill, USA.
Department of Athletic Training, High Point University, USA.
Clin Biomech (Bristol). 2021 Apr;84:105345. doi: 10.1016/j.clinbiomech.2021.105345. Epub 2021 Mar 31.
Altered gait biomechanics have been linked to post-traumatic knee osteoarthritis development following anterior cruciate ligament reconstruction surgery, but the persistence of aberrant gait biomechanics after the first year post-surgery is inconsistent in the literature. Gait biomechanics are typically evaluated on a level surface, but this task may not elucidate discrepancies in individuals further removed from surgery due to the simplicity of the task. Graded surfaces are common in real-world ambulation and may exacerbate aberrant gait biomechanics due to greater mechanical demands.
Forty-seven individuals post-anterior cruciate ligament reconstruction (4 ± 3 years post-surgery) and forty-seven uninjured controls completed gait analysis under level, uphill, and downhill conditions on an instrumented treadmill. Outcomes included knee flexion displacement and peak knee flexion angle, vertical ground reaction force, and knee extension and abduction moments.
Knee extension moment and knee flexion displacement were lesser in the surgical limb compared to the contralateral during the downhill condition, with lesser knee flexion displacement also observed during the level condition. Additionally, knee extension moment was less symmetrical in the surgical group during both uphill and downhill conditions compared to controls. Knee flexion displacement was less symmetrical in the surgical group during both level and downhill conditions compared to controls.
Graded surfaces elucidate aberrant gait biomechanics in individuals more than 1 year post-anterior cruciate ligament reconstruction that are not apparent during level walking. These findings suggest that gait assessment on level surfaces may mask existing deficiencies, and warrant emphasizing ambulation of graded surfaces during anterior cruciate ligament rehabilitation.
前交叉韧带重建手术后，改变的步态生物力学与创伤后膝关节骨关节炎的发展有关，但术后第一年异常步态生物力学的持续存在在文献中并不一致。步态生物力学通常在水平表面上进行评估，但由于任务简单，对于距离手术时间较长的个体，这种任务可能无法揭示差异。分级表面在现实世界的步行中很常见，由于机械需求增加，可能会加剧异常步态生物力学。
47 名前交叉韧带重建术后患者（术后 4±3 年）和 47 名未受伤的对照者在仪器化跑步机上的水平、上坡和下坡条件下完成步态分析。结果包括膝关节屈曲位移和最大膝关节屈曲角度、垂直地面反作用力以及膝关节伸展和外展力矩。
在下坡条件下，手术侧的膝关节伸展力矩和膝关节屈曲位移小于对侧，在水平条件下也观察到膝关节屈曲位移较小。此外，与对照组相比，手术组在上坡和下坡条件下的膝关节伸展力矩都不对称。与对照组相比，手术组在水平和下坡条件下的膝关节屈曲位移都不对称。
分级表面阐明了前交叉韧带重建术后 1 年以上个体的异常步态生物力学，而在水平步行时这些生物力学并不明显。这些发现表明，在水平表面进行步态评估可能会掩盖现有的缺陷，在前交叉韧带康复过程中需要强调分级表面的步行。
