title: Gait patterns differ between ACL-reconstructed athletes who pass return-to-sport criteria and those who fail.
abstract: BACKGROUND
  The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function.
  
  
  OBJECTIVE
  When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries.
  
  
  RESULTS
  Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee (P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria.
  
  
  CONCLUSIONS
  Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their poorer performing counterparts. Patients who did not pass RTS criteria not only demonstrated larger kinematic and kinetic asymmetries between limbs but also appeared to use a gait strategy more closely aligned with athletes early after ACL rupture.
  
  
  CONCLUSIONS
  Poor performance on a battery of functional performance measures may be related to the presence of movement asymmetries in athletes after ACL reconstruction. Objective RTS criteria have the potential to provide information to clinicians who determine when these athletes return to activity, and may aid in the prescription of targeted rehabilitation to address underlying movement asymmetry.
authors.affiliation: The Ohio State University Sports Medicine, Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA. sldistasi@gmail.com
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Di Stasi
authors.forename: David
authors.initials: D
authors.lastname: Logerstedt
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gardinier
authors.forename: Lynn
authors.initials: L
authors.lastname: Snyder-Mackler
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001696:Biomechanical Phenomena; D005080:Exercise Test; D005260:Female; D005684:Gait / Q000502:physiology*; D006615:Hip / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007717:Knee / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D053580:Muscle Strength; D052097:Quadriceps Muscle / Q000502:physiology; D020127:Recovery of Function; D055815:Young Adult
keywords: ACL reconstruction; function; gait mechanics; noncopers; return to sport
references.citation: J Appl Biomech. 2012 Aug;28(4):374-86
references.pmid: 22983931
references.citation: J Orthop Sports Phys Ther. 2000 Apr;30(4):194-203
references.pmid: 10778796
references.citation: Clin J Sport Med. 2007 Jul;17(4):258-62
references.pmid: 17620778
references.citation: J Electromyogr Kinesiol. 1998 Dec;8(6):349-62
references.pmid: 9840891
references.citation: Med Sci Sports Exerc. 1999 Feb;31(2):210-5
references.pmid: 10063808
references.citation: Am J Sports Med. 2010 Oct;38(10):1968-78
references.pmid: 20702858
references.citation: Clin Biomech (Bristol, Avon). 2010 Mar;25(3):222-9
references.pmid: 20005613
references.citation: J Orthop Sports Phys Ther. 2008 Oct;38(10):586-95
references.pmid: 18979658
references.citation: J Orthop Sports Phys Ther. 2008 Feb;38(2):36-41
references.pmid: 18560190
references.citation: J Bone Joint Surg Am. 1998 Aug;80(8):1132-45
references.pmid: 9730122
references.citation: Knee Surg Sports Traumatol Arthrosc. 2000;8(2):76-82
references.pmid: 10795668
references.citation: Ann Phys Rehabil Med. 2010 Dec;53(10):598-614
references.pmid: 21112824
references.citation: Phys Ther Sport. 2008 May;9(2):97-104
references.pmid: 19083709
references.citation: J Orthop Sports Phys Ther. 2012 Jul;42(7):601-14
references.pmid: 22402434
references.citation: Arthritis Rheum. 2004 Oct;50(10):3145-52
references.pmid: 15476248
references.citation: J Appl Biomech. 2012 Aug;28(4):366-73
references.pmid: 22983930
references.citation: Int Orthop. 2011 Apr;35(4):607-13
references.pmid: 21127860
references.citation: Am J Sports Med. 1991 Sep-Oct;19(5):513-8
references.pmid: 1962720
references.citation: Arthritis Rheum. 2009 Dec;60(12):3693-702
references.pmid: 19950260
references.citation: Eur J Appl Physiol. 2003 May;89(3-4):301-8
references.pmid: 12736838
references.citation: Clin J Sport Med. 2011 May;21(3):249-58
references.pmid: 21519299
references.citation: Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805
references.pmid: 21932078
references.citation: Ann Rheum Dis. 2004 Mar;63(3):269-73
references.pmid: 14962961
references.citation: J Orthop Res. 2009 Jun;27(6):724-9
references.pmid: 19023893
references.citation: Ann Rheum Dis. 1996 Sep;55(9):622-6
references.pmid: 8882132
references.citation: Ann Biomed Eng. 2004 Mar;32(3):447-57
references.pmid: 15095819
references.citation: Sports Med. 2004;34(4):269-80
references.pmid: 15049718
references.citation: Osteoarthritis Cartilage. 2006 Feb;14(2):114-9
references.pmid: 16242972
references.citation: J Orthop Sports Phys Ther. 2006 Jun;36(6):385-402
references.pmid: 16776488
references.citation: Knee Surg Sports Traumatol Arthrosc. 2001;9(2):62-71
references.pmid: 11354855
references.citation: Med Sci Sports Exerc. 2008 Feb;40(2):215-22
references.pmid: 18202582
references.citation: Arthritis Rheum. 1999 Mar;42(3):534-44
references.pmid: 10088777
references.citation: Med Sci Sports Exerc. 1998 Oct;30(10):1481-8
references.pmid: 9789847
references.citation: Int Orthop. 2012 Jan;36(1):171-7
references.pmid: 21898038
references.citation: Knee Surg Sports Traumatol Arthrosc. 2008 May;16(5):442-8
references.pmid: 18292988
references.citation: J Pediatr Orthop. 2009 Jul-Aug;29(5):486-9
references.pmid: 19568022
references.citation: Am J Sports Med. 2011 Mar;39(3):538-43
references.pmid: 21098818
references.citation: J Orthop Sports Phys Ther. 2010 Mar;40(3):141-54
references.pmid: 20195019
references.citation: J Electromyogr Kinesiol. 2004 Oct;14(5):565-75
references.pmid: 15301775
references.citation: Am J Sports Med. 2012 Oct;40(10):2256-63
references.pmid: 22879403
references.citation: J Biomech. 2011 Jul 7;44(10):1948-53
references.pmid: 21592482
references.citation: Clin Biomech (Bristol, Avon). 2010 May;25(4):277-83
references.pmid: 20097459
references.citation: Am J Sports Med. 2009 Feb;37(2):246-51
references.pmid: 19109531
references.citation: J Orthop Sports Phys Ther. 2011 Jun;41(6):377-87
references.pmid: 21289456
references.citation: Arthroscopy. 1994 Aug;10(4):434-41
references.pmid: 7945641
references.citation: J Orthop Sports Phys Ther. 2012 Sep;42(9):750-9
references.pmid: 22813542
references.citation: Clin Biomech (Bristol, Avon). 2012 May;27(4):360-5
references.pmid: 22061048
references.citation: Psychol Bull. 1992 Jul;112(1):155-9
references.pmid: 19565683