Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 8, pp 1271–1276 | Cite as

Anterior cruciate ligament reconstruction improves the metabolic energy cost of level walking at customary speeds

  • Mehmet Colak
  • Irfan Ayan
  • Ugur Dal
  • Turan Yaroglu
  • Figen Dag
  • Cengiz Yilmaz
  • Huseyin Beydagi
Knee
First Online:
Received:
Accepted:

Abstract

Purpose

The metabolic energy cost of walking is altered by pathological changes in gait. It is thought that anterior cruciate ligament (ACL) deficiency alters the energy requirement for level walking through its effect on gait pattern. In this study, it is hypothesised that the metabolic energy cost of walking would improve after ACL reconstruction.

Methods

Eight patients who were undergoing ACL reconstruction for an isolated rupture were included in this prospective study. Clinical examinations, Lysholm scores and metabolic tests were performed preoperatively and at 3, 6 and 12 months after ACL reconstruction using autologous quadruple hamstring tendons. For the metabolic evaluation, net oxygen cost was calculated while walking on a treadmill at 50-, 70- and 90-m/min velocities. A two-way factorial ANOVA was performed in order to evaluate the primary effects and interactions of the time point and velocity variables on net oxygen cost.

Results

All patients had positive Lachman and anterior drawer tests preoperatively that became negative postoperatively and remained negative until the last follow-up point. The mean preoperative Lysholm score was 66, whereas the mean postoperative follow-up scores were 85, 91 and 94, respectively. The interaction between follow-up time point and velocity was not significant. Regardless of the selected velocity, the net oxygen cost was lower than that at preoperative levels at each postoperative time point (p < 0.05).

Conclusion

The results of the present study indicate that the energy cost of level walking in chronic ACL-deficient patients improves after ACL reconstruction. Cause–effect-based studies with correlation evaluations that compare kinetic, kinematic and electromyographic data and metabolic cost calculations should facilitate more accurate analyses.

Level of evidence

Therapeutic study, Level 4.

Keywords

Anterior cruciate ligament Anterior cruciate ligament reconstruction Energy expenditure of walking Gait Oxygen cost 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We would like to thank to A. Taner Erdogan for his valuable support.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Baker R, Hausch A, McDowell B (2001) Reducing the variability of oxygen consumption measurements. Gait Posture 13:202–209PubMedCrossRefGoogle Scholar
  2. 2.
    Berchuck M, Andriacchi TP, Bach BR, Reider B (1990) Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg Am 72:871–877PubMedGoogle Scholar
  3. 3.
    Brehm MA, Knol DL, Harlaar J (2008) Methodological considerations for improving the reproducibility of walking efficiency outcomes in clinical gait studies. Gait Posture 27:196–201PubMedCrossRefGoogle Scholar
  4. 4.
    Bulgheroni P, Bulgheroni MV, Andrini L, Guffanti P, Giughello A (1997) Gait patterns after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 5:14–21PubMedCrossRefGoogle Scholar
  5. 5.
    Bush-Joseph CA, Hurwitz DE, Patel RR, Bahrani Y, Garretson R, Bach BR Jr (2001) Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon. Am J Sports Med 29:36–41PubMedGoogle Scholar
  6. 6.
    Ciccotti MG, Kerlan RK, Perry J, Pink M (1994) An electromyographic analysis of the knee during functional activities. II. The anterior cruciate ligament-deficient and -reconstructed profiles. Am J Sports Med 22:651–658PubMedCrossRefGoogle Scholar
  7. 7.
    Dal U, Erdogan T, Resitoglu B, Beydagi H (2010) Determination of preferred walking speed on treadmill may lead to high oxygen cost on treadmill walking. Gait Posture 31:366–369PubMedCrossRefGoogle Scholar
  8. 8.
    DeVita P, Hortobagyi T, Barrier J (1998) Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation. Med Sci Sports Exerc 30:1481–1488PubMedCrossRefGoogle Scholar
  9. 9.
    Devita P, Hortobagyi T, Barrier J, Torry M, Glover KL, Speroni DL, Money J, Mahar MT (1997) Gait adaptations before and after anterior cruciate ligament reconstruction surgery. Med Sci Sports Exerc 29:853–859PubMedGoogle Scholar
  10. 10.
    Ferber R, Osternig LR, Woollacott MH, Wasielewski NJ, Lee JH (2002) Gait mechanics in chronic ACL deficiency and subsequent repair. Clin Biomech (Bristol, Avon) 17:274–285CrossRefGoogle Scholar
  11. 11.
    Hooper DM, Morrissey MC, Drechsler WI, Clark NC, Coutts FJ, McAuliffe TB (2002) Gait analysis 6 and 12 months after anterior cruciate ligament reconstruction surgery. Clin Orthop Relat Res 403:168–178PubMedCrossRefGoogle Scholar
  12. 12.
    Martin PE, Rothstein DE, Larish DD (1992) Effects of age and physical activity status on the speed–aerobic demand relationship of walking. J Appl Physiol 73:200–206PubMedGoogle Scholar
  13. 13.
    McHugh MP, Spitz AL, Lorei MP, Nicholas SJ, Hershman EB, Gleim GW (1994) Effect of anterior cruciate ligament deficiency on economy of walking and jogging. J Orthop Res 12:592–597PubMedCrossRefGoogle Scholar
  14. 14.
    Moraiti CO, Stergiou N, Vasiliadis HS, Motsis E, Georgoulis A (2010) Anterior cruciate ligament reconstruction results in alterations in gait variability. Gait Posture 32:169–175PubMedCrossRefGoogle Scholar
  15. 15.
    Noyes FR, Matthews DS, Mooar PA, Grood ES (1983) The symptomatic anterior cruciate-deficient knee. Part II: the results of rehabilitation, activity modification, and counselling on functional disability. J Bone Joint Surg Am 65:163–174PubMedGoogle Scholar
  16. 16.
    Ozyener F, Rossiter HB, Ward SA, Whipp BJ (2001) Influence of exercise intensity on the on- and off-transient kinetics of pulmonary oxygen uptake in humans. J Physiol 533:891–902PubMedCrossRefGoogle Scholar
  17. 17.
    Roberts CS, Rash GS, Honaker JT, Wachowiak MP, Shaw JC (1999) A deficient anterior cruciate ligament does not lead to quadriceps avoidance gait. Gait Posture 10:189–199PubMedCrossRefGoogle Scholar
  18. 18.
    Schwartz MH (2007) Protocol changes can improve the reliability of net oxygen cost data. Gait Posture 26:494–500PubMedCrossRefGoogle Scholar
  19. 19.
    Schwartz MH, Koop SE, Bourke JL, Baker R (2006) A nondimensional normalization scheme for oxygen utilization data. Gait Posture 24:14–22PubMedCrossRefGoogle Scholar
  20. 20.
    Timoney JM, Inman WS, Quesada PM, Sharkey PF, Barrack RL, Skinner HB, Alexander AH (1993) Return of normal gait patterns after anterior cruciate ligament reconstruction. Am J Sports Med 21:887–889PubMedCrossRefGoogle Scholar
  21. 21.
    Traballesi M, Porcacchia P, Averna T, Brunelli S (2008) Energy cost of walking measurements in subjects with lower limb amputations: a comparison study between floor and treadmill test. Gait Posture 27:70–75PubMedCrossRefGoogle Scholar
  22. 22.
    Van de Putte M, Hagemeister N, St-Onge N, Parent G, de Guise JA (2006) Habituation to treadmill walking. Biomed Mater Eng 16(1):43–52PubMedGoogle Scholar
  23. 23.
    Waters RL, Lunsford BR, Perry J, Byrd R (1988) Energy-speed relationship of walking: standard tables. J Orthop Res 6:215–222PubMedCrossRefGoogle Scholar
  24. 24.
    Waters RL, Mulroy S (1999) The energy expenditure of normal and pathologic gait. Gait Posture 9:207–231PubMedCrossRefGoogle Scholar
  25. 25.
    Wexler G, Hurwitz DE, Bush-Joseph CA, Andriacchi TP, Bach BR Jr (1998) Functional gait adaptations in patients with anterior cruciate ligament deficiency over time. Clin Orthop Relat Res 348:166–175PubMedCrossRefGoogle Scholar
  26. 26.
    Winiarski S (2008) Mechanical energy fluctuations during walking of healthy and ACL-reconstructed subjects. Acta Bioeng Biomech 10:57–63PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Mehmet Colak
    • 1
    • 3
  • Irfan Ayan
    • 1
  • Ugur Dal
    • 2
  • Turan Yaroglu
    • 1
  • Figen Dag
    • 2
  • Cengiz Yilmaz
    • 1
  • Huseyin Beydagi
    • 2
  1. 1.Department of Orthopaedics and Traumatology, School of MedicineUniversity of MersinMersinTurkey
  2. 2.Department of Physiology, School of MedicineUniversity of MersinMersinTurkey
  3. 3.Mersin Universitesi Tip Fakultesi HastanesiMersinTurkiye

Personalised recommendations