Document Title: DeVita-MSSE-Jul97.shtml
Article Title: Gait adaptations before and after anterior cruciate ligament reconstruction surgery
Authors: DeVita, Paul; Hortobagyi, Tibor; Barrier, Jason; Torry, Michael; Gover, Karthryn L.; Speroni, David L.; Money, Jeffrey; Mahar, Matthew T.
Publication: Medicine and Science in Sports and Exercise, American College of Sports Medicine
Date: July 1997
Volume 29, Number 7, July 1997, pp 853-859
Keywords: ACL injury, walking, gait adaptation, locomotion, ambulation, biomechanics, rehabilitation, stride phase, stance phase.

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Comments: DeVita et al. found that ACL deficiency results in subtle yet profound alterations in one's gait (walking pattern). Most notable is a reduction in quadriceps activity, combined with a marked increase in hamstring activity...ostensibly to reduce the anterior drawer that is such a hallmark of ACLlessness. The authors found that although some recovery does occur over time, many aspects of knee-joint kinetics lag behind for protracted periods of time. A very pronounced reduction in work done by the ACL-deficient knee was noted; this greatly reduced work output may explain why returning to knee-strenuous sports after ACL reconstruction requires such an arduous and extensive rehabilitation. (Ultimately, the rehabilitation from ACL reconstruction is a lifelong thing: the need for dedicated single-leg exercises remains for the rest of one's life.) The authors also note significant effects at the hip, and they recommend that people who undergo ACL reconstruction should endeavour to strength their hip-extensor musculature prior to or pursuant to the surgery. This penetratingly insightful article is a must-read for anyone with any type of ACL-injury history, and its thought-provoking findings dovetail nicely with other proprioception-related research published by DeVita and others. (See, for example, DeVita-AJSM-Nov98.shtml, DeVita-JB-Sep96.shtml, Torry-JPO-Jul01.shtml, Beynnon-AJSM-Mar99.shtml, and Wojtys-AJSM-Jul96.shtml.)

ABSTRACT

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

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