Büttner Christin, Lisee Caroline, Buck Ashley, Bjornsen Elizabeth, Thoma Louise, Spang Jeffrey, Blackburn Troy, Pietrosimone Brian
Department of Exercise and Sport Science.
Institute of Human Movement Science and Health, Chemnitz University of Technology, Germany.
J Athl Train. 2025 Feb 1;60(2):92-102. doi: 10.4085/1062-6050-0464.23.
CONTEXT: Gait biomechanics and daily steps are important aspects of knee-joint loading that change after anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help clinicians develop comprehensive rehabilitation interventions that promote optimal joint loading after injury, thereby improving long-term knee-joint health. OBJECTIVES: To compare biomechanical gait waveforms throughout stance at early time points post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR and to examine how these gait waveforms compare with those of uninjured controls. DESIGN: Case-control study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 32 individuals with primary ACLR assigned to the low-step group (LSG; n = 13) or the high-step group (HSG; n = 19) based on their average daily steps at 6 months post-ACLR and 32 uninjured matched controls. MAIN OUTCOME MEASURE(S): Gait biomechanics were collected at 2, 4, and 6 months post-ACLR for the ACLR groups and at a single session for the control group. Knee-adduction moment, knee-extension moment (KEM), and knee-flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% CIs between groups were reported. RESULTS: Primary results demonstrated less KFA (1%-45% versus 79%-92% of stance) and greater KEM (65%-93% of stance) at 2 months and greater knee-adduction moment (14%-20% versus 68%-92% of stance) at 4 months post-ACLR for the HSG compared with the LSG. Knee-adduction moment, KEM, and KFA waveforms differed across various proportions of stance at all time points between the step and control groups. CONCLUSIONS: Differences in gait biomechanics were present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily step behaviors post-ACLR.
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