Activity progression for anterior cruciate ligament injured individuals.
BACKGROUND
Functional exercises are important in the rehabilitation of anterior cruciate ligament deficient and reconstructed individuals but movement compensations and incomplete recovery persist. This study aimed to identify how tasks pose different challenges; and evaluate if different activities challenge patient groups differently compared to controls.


METHODS
Motion and force data were collected during distance hop, squatting and gait for 20 anterior cruciate ligament deficient, 21 reconstructed and 21 controls.


RESULTS
Knee range of motion was greatest during squatting, intermediate during hopping and smallest during gait (P < 0.01). Peak internal knee extensor moments were greatest during distance hop (P < 0.01). The mean value of peak knee moments was reduced in squatting and gait (P < 0.01) compared to hop. Peak internal extensor moments were significantly larger during squatting than gait and peak external adductor moments during gait compared to squatting (P < 0.01). Fluency was highest during squatting (P < 0.01). All patients demonstrated good recovery of gait but anterior cruciate ligament deficient adopted a strategy of increased fluency (P < 0.01). During squatting knee range of motion and peak internal knee extensor moment were reduced in all patients (P < 0.01). Both anterior cruciate ligament groups hopped a shorter distance (P < 0.01) and had reduced knee range of motion (P < 0.025). Anterior cruciate ligament reconstructed had reduced fluency (P < 0.01).


CONCLUSIONS
Distance hop was most challenging; squatting and gait were of similar difficulty but challenged patients in different ways. Despite squatting being an early, less challenging exercise, numerous compensation strategies were identified, indicating that this may be more challenging than gait.
School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom; Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom; Cardiff and Vale University Health Board, Cardiff, United Kingdom. Electronic address: buttonk@cardiff.ac.uk.
Kate
K
Button
School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom; Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom.
Paulien E
PE
Roos
School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom; Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom.
Robert W M
RW
van Deursen
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005081:Exercise Therapy; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D055815:Young Adult
Anterior cruciate ligament; Clinical biomechanics; Functional exercise; Knee joint; Movement analysis; Physiotherapy; Rehabilitation