School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI, USA.
School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Neuromuscular and Rehabilitation Robotics Laboratory, University of Michigan, Ann Arbor, MI, USA; Robotics Institute, University of Michigan, Ann Arbor, MI, USA.
Clin Biomech (Bristol). 2023 Aug;108:106059. doi: 10.1016/j.clinbiomech.2023.106059. Epub 2023 Jul 28.
Walking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction.
We recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior).
We observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η = 0.13-0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η range = 0.13-0.25, p < 0.05).
Overall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.
前交叉韧带重建后，步行生物力学通常会受到影响，且与未受伤的对照组不同。已经证明，在膝关节手术后的早期阶段，通过改变任务难度可以影响步行障碍的严重程度，但尚不清楚术后后期的患者是否会受到不同任务需求的类似影响。在这里，我们评估了改变步行速度对前交叉韧带重建患者和未受伤对照者下肢之间差异的地面反作用力和膝关节生物力学的影响。
我们招募了 28 名前交叉韧带重建患者和 20 名未受伤的对照者，让他们在三种速度（自主选择、120%自主选择速度和 80%自主选择速度）下进行步行评估。主要结果包括矢状面膝关节力矩、角度、运动范围和地面反作用力（垂直和前后）。
我们观察到步行速度对前交叉韧带重建患者的力和膝关节结果有不同的影响。前交叉韧带重建患者的下肢之间的差异在快速行走时增加，在慢速行走时减小，而未受伤的参与者无论速度如何都保持下肢之间的差异（部分 η=0.13-0.33，p<0.05）。前交叉韧带重建患者在 GRF 和矢状面膝关节力矩方面相对于对侧和未受伤的对照组对手术侧进行了减载（部分 η 范围=0.13-0.25，p<0.05）。
总的来说，我们的研究结果强调了即使完成了正式的康复，前交叉韧带重建患者仍然存在步行障碍。进一步的研究应该考虑确定那些在对快速行走的步态不对称性变化反应中表现出更大变化的人是否也表现出较差的力量和/或关节健康结果。
