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Anterior cruciate ligament deficiency reduces walking economy in “copers” and “non-copers”

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patients with ACL injury requiring surgical treatment (non-copers) demonstrate altered neuromuscular control and gait pattern compared with those returning to their pre-injury activities without surgery (copers). Pathological gait pattern may increase the energy cost of walking. We compared the energy cost of flat, uphill, and downhill walking between ACL-deficient and healthy individuals and between “copers” and “non-copers”.

Methods

Nineteen young males with unilateral ACL injury were allocated into “copers” and “non-copers” according to their ability to return to pre-injury activity without ACL reconstruction. Lysholm and IKDC scales were recorded, and a control group (n = 10) matched for physical characteristics and activity levels was included. All participants performed 8-min walking tasks at 0, +10, and −10 % gradients. Energy cost was assessed by measurement of oxygen consumption (VO2). HR and ventilation (VE), respiratory exchange ratio (RER), and VE/VO2 were also measured.

Results

VO2 and HR were higher in ACL-deficient patients than in controls during walking at 0, +10, and −10 % gradients (p < 0.01–0.05). There were no differences between “copers” and “non-copers” in VO2 and HR for any gradient. No differences were observed in VE, RER, and VE/VO2 among the three groups.

Conclusions

The walking economy of level, uphill, and downhill walking is reduced in ACL-deficient patients. Despite the improved functional and clinical outcome of “copers”, their walking economy appears similar to that of “non-copers” but impaired compared with healthy individuals. The higher energy demand and effort during locomotion in “copers” and “non-copers” has clinical implications for designing safer rehabilitation programmes. The increased energy cost in “copers” may be another parameter to consider when deciding on the most appropriate therapeutic intervention (operative and non-operative), particularly for athletes.

Level of evidence

II.

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Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedics, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Thessaloniki, 56403, Greece

    Efthymios Iliopoulos MD, Nikiforos Galanis MD, PhD, Michael Potoupnis MD, PhD & John Kirkos MD, PhD

  2. Sports Medicine Unit, 2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece

    Michael Iosifidis MD, PhD

  3. Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece

    Andreas Zafeiridis PhD & Ioannis S. Vrabas PhD

  4. 1st Department of Orthopaedics, Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Pericles Papadopoulos MD, PhD

  5. Department of Sport Medicine and Biology of Exercise, School of Physical Education and Sport Science, University of Athens, Athens, Greece

    Nikolaos Geladas PhD

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  1. Efthymios Iliopoulos MD
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  2. Nikiforos Galanis MD, PhD
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Correspondence to Nikiforos Galanis MD, PhD.

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Iliopoulos, E., Galanis, N., Iosifidis, M. et al. Anterior cruciate ligament deficiency reduces walking economy in “copers” and “non-copers”. Knee Surg Sports Traumatol Arthrosc 25, 1403–1411 (2017). https://doi.org/10.1007/s00167-015-3709-2

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  • DOI: https://doi.org/10.1007/s00167-015-3709-2

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