Full length articleUpper body accelerations during walking are altered in adults with ACL reconstruction
Introduction
The anterior cruciate ligament plays an important role in stabilizing the knee joint during walking and running activities. Following injury or damage to this ligament that results in a tear, reconstruction is often advised to improve stability of the knee joint. Unfortunately, while this surgery may lead to short-term benefits for maintaining knee stability, there are long term health concerns for persons who undergo anterior cruciate ligament reconstruction (ACLR). In particular, individuals who undergo ACLR surgery demonstrated a prevalence for developing osteoarthritis in the reconstructed knee in less than 12 years post-surgery [1]. One reason for the development of early-onset osteoarthritis relates to changes in ones walking pattern following ACLR [2], [3]. However, previous reports have struggled to identify clear gait differences for individuals following this surgery. For example, many people with ACLR exhibit similar spatiotemporal parameters [4], [5] and gait kinematics [5], [6], [7] compared to healthy controls. Additionally, similar kinetic and kinematic patterns are observed when compared to the contralateral limb within a single person [8]. The result of these collective findings is that approximately 90% of all ACLR individuals appear clinically to have “normal” knee function, defined by similarities in spatiotemporal parameters and mechanical properties of the knee [9]. The only consistent difference has been with regard to the force developed during walking, with increases in vertical ground reaction forces (GRF) and joint moments being reported for ACLR persons [6].
While the majority of previous studies have focused on the localized effects of this reconstructive surgery (i.e. its effect on the knee joint itself), it is possible that the impact of ACLR could be manifested at other parts of the body. For example, the upper body (i.e., trunk and neck) play an important role in damping gait-related oscillations during locomotion [10], [11], [12] to ensure the head is stabilized [13], [14]. This stabilization is evident in decreased amplitude of acceleration patterns at the head when compared to the lower trunk [15], [16]. Previous research has shown that the ability of the trunk-neck region to effectively control accelerations during walking is affected by both increasing age and for clinical populations [14], [15], [16], [17], [18]. If ACLR affects the capacity of the knee joint to appropriately dissipate forces within the lower limb during walking [19], then it is possible that impact of this surgery may also influence the dynamics of the upper body regions during gait. However, there has been no direct assessment of whether ACLR impacts the ability of the upper body to attenuate oscillations while walking.
This study was designed to assess and compare whether individuals who have had an ACL reconstruction demonstrate upper body acceleration patterns similar to healthy subjects. It was predicted that ACLR individuals would demonstrate a diminished capacity to compensate for gait-related oscillations, especially at higher frequencies.
Section snippets
Participants
Seventeen individuals with unilateral ACLR (age:23.5 ± 2.73 years, height:172.9 ± 9.07 cm, weight:77.4 ± 13.78 kg) and 17 age/height/weight matched control (CTRL) persons (age:25 ± 2.44 years, height:173.2 ± 10.52 cm, weight:75.7 ± 14.97 kg) participated in the study. There were no significant differences between the two groups with regards to age, height, or weight (p’s > 0.05). Inclusion criteria for the CTRL group included no previous history of lower extremity injuries, surgeries, or neuropathy. For the ACLR
Descriptive gait data
There was no significant group difference for preferred gait speed between participants (ACLR: 1.24 ± 0.15meters/sec, CTRL: 1.31 ± 0.16meters/sec; t(132) = 1.54, p = 0.133). An example of the typical acceleration profile for the head and trunk segments across the AP, ML and VT directions is shown in Fig. 1.
RMS acceleration
Fig. 2, which contains mean RMS values for each segment across the two groups, illustrates that the gait-related accelerations decreased from the trunk to the head. In the AP direction, there was a
Discussion
This study was designed to assess and compare the pattern of acceleration for the lower trunk, neck and head for individuals with unilateral ACL reconstruction compared to healthy adults. While there were similarities in the general acceleration patterns between the two groups, the ACLR individuals exhibited a diminished ability to attenuate frequency oscillations in the AP and ML directions. Further, the time-dependent structure of the acceleration signal for the head and neck in the VT
Conclusions
While both groups demonstrated a similar pattern of gait-related accelerations during over-ground walking, subtle differences were found with ACLR individuals demonstrating increased complexity of VT accelerations and a reduced capacity to compensate for accelerations in the AP and ML directions between segments. These results indicate that trunk-neck-head axes of ACLR persons may have a reduced ability to filter out gait-related fluctuations, which has the potential to negatively impact head
Conflicts of interest
None.
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