Principal component analysis of knee kinematics and kinetics after anterior cruciate ligament reconstruction☆
Highlights
► We identify knees of ACL reconstructed subjects that fall outside normal ranges. ► Principal component models were developed for dynamic gait measures. ► These models were used to assess gait waveforms of ACL reconstructed subjects. ► The majority of differences occurred in the abduction–adduction knee moment.
Section snippets
Background
More than 250,000 people tear their anterior cruciate ligament (ACL) in the United States each year. ACL injury often leads to kinematic changes in the knee, resulting in instability, and osteoarthritic changes over time [1], [2]. In vivo studies of squatting and walking have shown increased anterior–posterior translation and altered internal–external (IE) rotation of the tibia with respect to the femur in ACL deficient knees using a variety of methods, including MRI [3], fluoroscopy [2], and
Subjects
Twenty-two subjects participated in this investigation. Ten (four male and six female) ACL reconstructed individuals were compared with 12 (six male and six female) healthy uninjured height- and weight-matched control subjects. The mean body weight and height of the ACL reconstructed subjects were 77.6 kg (SD 19.5 kg) and 1.73 m (SD 0.10 m). The ACL reconstructed subjects had sustained an isolated unilateral ACL tear during sports activity and were surgically reconstructed with bone-patellar
Results
PC models were developed for each of the knee angles and moments (Table 1). The number of PCs retained in each model (k) was chosen through an 85% trace criterion [8], [9]. Table 2 provides a gait assessment of the ACL subjects using the PC models. A significant difference from normal implies that either or both the T2 and the Q values are above the upper limits defined by control subjects. Of the 10 ACL subjects, nine showed deviation from normal gait in either or both knees in at least one of
Discussion
We hypothesized that alterations in 3-dimensional knee rotations and moments during the stance phase of gait could be detected as outliers following ACL reconstruction using principal component analysis. The work presented here shows that abnormalities in gait waveforms can be detected in subjects who have undergone ACL reconstruction surgery. Of the 20 knees analyzed, 45% displayed abnormal adduction moment waveforms during the stance phase of gait. These included both ACL reconstructed and
Conclusions
Principal component analysis enabled us to identify gait waveforms which deviate from normal as assessed using a control population. We determined in a sample of 10 ACL reconstructed subjects that six of the ACL reconstructed knees had not returned to normal following surgery and that eight of the contralateral knees functioned differently, presumably as a result of alterations in the reconstructed knee. We believe that each subject has a unique response to their injury and reconstructive
Conflict of interest statement
The authors declare that they have no competing interests.
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Supported in part by a grant from FedEx Institute of Technology.
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These authors contributed equally to this work.