Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
BACKGROUND
Abnormal gait after anterior cruciate ligament reconstruction (ACLR) may contribute to development and/or progression of knee osteoarthritis.


OBJECTIVE
To conduct a systematic review and meta-analysis of knee kinematics and joint moments during walking after ACLR.


METHODS
We searched seven electronic databases and reference lists of relevant papers, for cross-sectional, human-based observational studies comparing knee joint kinematics and moments during level walking in individuals with ACLR, with the uninjured contralateral knee or healthy individuals as a control. Two independent reviewers appraised methodological quality (modified Downs and Black scale). Where possible, data were pooled by time post-ACLR (RevMan), otherwise narrative synthesis was undertaken.


RESULTS
Thirty-four studies were included. Meta-analysis revealed significant sagittal plane deficits in ACLR knees. We found greater knee flexion angles (standardised mean difference: 1.06; 95% CI 0.39 to 1.74) and joint moments (1.61; 0.87 to 2.35) <6 months post-ACLR, compared to healthy controls. However, lower peak knee flexion angles were identified 1-3 years (-2.21; -3.16 to -1.26) and ≥3 years post-ACLR (-1.38, -2.14 to -0.62), and lower knee flexion moment 6-12 months post-ACLR (-0.76; -1.40 to -0.12). Pooled data provided strong evidence of no difference in peak knee adduction moment >3 years after ACLR (vs healthy controls) (0.09; -0.63 to 0.81). No transverse plane conclusions could be drawn.


CONCLUSIONS
Sagittal plane biomechanics, rather than the knee adduction moment, appear to be more relevant post-ACLR. Better understanding of sagittal plane biomechanics is necessary for optimal post-operative recovery, and to potentially prevent early onset and progression of knee OA after ACLR.


BACKGROUND
PROSPERO systematic review protocol registration number CRD4201400882 2.
Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia Melbourne School of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.
Harvi F
HF
Hart
School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Adam G
AG
Culvenor
Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Natalie J
NJ
Collins
Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia.
David C
DC
Ackland
Melbourne School of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
Sallie M
SM
Cowan
International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
Zuzana
Z
Machotka
School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
Kay M
KM
Crossley
D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology* / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction; D001696:Biomechanical Phenomena / Q000502:physiology; D005684:Gait / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D011184:Postoperative Period
Anterior cruciate ligament; Biomechanics; Knee