title: Knee loading asymmetries during gait and running in early rehabilitation following anterior cruciate ligament reconstruction: A longitudinal study.
abstract: BACKGROUND
  Normalization of gait is expected 8-12 weeks after anterior cruciate ligament reconstruction and is a criterion for progression to running. Long-term persistence of sagittal knee loading deficits suggests that early goals are not met. Magnitude and progression of deficits in gait during this time and their relationship to deficits in running are not known.
  
  
  METHODS
  12 individuals status-post reconstruction (5 males) underwent 3-dimensional motion analysis of gait after surgery: one (T1) and three (T2) months and at initiation of running (T3); and running T3. Repeated measures ANOVAs (limb × time) assessed differences in knee flexion, extensor moment impulse and negative work in gait; paired t-tests compared limbs during running; and Pearson's correlations determined associations between limb ratios (moment and work) in gait and running.
  
  
  RESULTS
  Less flexion (-4.4 (0.63) degrees; mean (SE)), 35% smaller extensor moment (-0.15 (0.006) Nm∗s/kg) and 47% less work (-0.03 (0.008) J/kg) were observed in the surgical knee during gait across time. Moment and work were 1.7 (-0.1 (0.03) Nm∗s/kg) and 1.6 times greater (-0.23 (0.047) J/kg) in non-surgical knee during running. Moment and work limb asymmetries correlated across time during gait (r=0.778-0.929, P<0.001) and to asymmetries during running.
  
  
  CONCLUSIONS
  Limb asymmetries in knee loading present one month after reconstruction persist 4 months post-reconstruction. Correlations between limb asymmetries during gait across time and to running suggest that early gait behaviors relate to longer-term loading. Greater attention should be placed on early gait training.
authors.affiliation: Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA 90089-9006, United States. Electronic address: sigward@usc.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sigward
authors.affiliation: Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA 90089-9006, United States.
authors.forename: Paige
authors.initials: P
authors.lastname: Lin
authors.affiliation: Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CHP 155, Los Angeles, CA 90089-9006, United States.
authors.forename: Kristamarie
authors.initials: K
authors.lastname: Pratt
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology; D012420:Running / Q000502:physiology*; D055815:Young Adult
keywords: Anterior cruciate ligament reconstruction; Early rehabilitation; Gait; Knee; Running