Anterior cruciate ligament reconstruction results in alterations in gait variability

Moraiti, Constantina O.; Stergiou, Nicholas; Vasiliadis, Haris S.; Motsis, Eustathios; Georgoulis, Anastasios

doi:10.1016/j.gaitpost.2010.04.008

« Previous Next »Gait & Posture
Volume 32, Issue 2 , Pages 169-175, June 2010

Anterior cruciate ligament reconstruction results in alterations in gait variability

Constantina O. Moraiti
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopeadic Surgery, University of Ioannina, Ioannina, Greece
Nicholas Stergiou
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68182, USA
Haris S. Vasiliadis
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopeadic Surgery, University of Ioannina, Ioannina, Greece
Eustathios Motsis
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopeadic Surgery, University of Ioannina, Ioannina, Greece
Anastasios Georgoulis
- Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopeadic Surgery, University of Ioannina, Ioannina, Greece
- Corresponding author at: Othopaedic Sports Medicine Center, PO Box 1330, Ioannina 45110, Greece. Tel.: +30 26510 64980; fax: +30 26510 64980.

Received 15 November 2008; received in revised form 10 April 2010; accepted 14 April 2010. published online 30 June 2010.

Abstract

Introduction

The temporal structure of gait variability has shown that healthy human gait exhibits long-range correlations and deterministic properties which allow the neuromuscular system to be flexible and adaptable to stresses. Pathology results in deterioration of these properties. We examined structure of gait variability after ACL reconstruction with either BPTB or quadrupled ST/G tendon autografts.

Methods

Six patients with BPTB reconstruction, six with ST/G reconstruction and six healthy controls walked on a treadmill at their self-selected pace. Two minutes of continuous kinematic data were recorded with a 6-camera optoelectronic system. The nonlinear measure of the largest Lyapunov Exponent (LyE) was estimated from the knee flexion-extension time series from 100 continuous walking strides to assess the structure of gait variability.

Results

The reconstructed limbs in both reconstructed groups exhibited significantly larger LyE values than the control limbs (p<0.05), even though clinical outcomes indicated complete restoration. No significant differences were found between the two autografts. In addition, the intact contralateral leg produced significant higher LyE values as compared with the ACL-reconstructed leg in both groups. No interaction was found.

Discussion

The larger LyE values indicate that the reconstructed knees of both reconstructed groups exhibit more divergence in the movement trajectories during gait. The larger Lye values found in the intact leg in both reconstructed groups could be interpreted as a compensatory mechanism. However, the increased divergence found in both limbs may present an alternative explanation for the impaired neuromuscular performance and increased susceptibility to future pathology, which is supported by the increased amount of osteoarthritis found in ACL-reconstructed patients.

Keywords: Motion analysis, Nonlinear analysis, Lyapunov Exponent, Gait, Variability