Advertisement

Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review

  • Benoit Pairot-de-Fontenay
  • Richard W. WillyEmail author
  • Audrey R. C. Elias
  • Ryan L. Mizner
  • Marc-Olivier Dubé
  • Jean-Sébastien Roy
Systematic Review

Abstract

Background

A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability.

Objective

The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics.

Methods

MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined.

Results

A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R.

Conclusion

After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability.

Systematic review registration

Registered in PROSPERO 2017, CRD42017077130.

Notes

Author Contributions

All authors contributed significantly to the review. BPdF was responsible for the conception of the review question and the extraction, analysis and interpretation of the data. ARCE and M-OD assisted with the risk of bias assessment and data extraction. J-SR assisted in the review design and revision of the manuscript. RWW and RLM provided advice throughout the review and contributed to the revision of the manuscript.

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of Interest

Benoit Pairot-de-Fontenay, Richard W. Willy, Audrey R.C. Elias, Ryan L. Mizner, Marc-Olivier Dubé and Jean-Sébastien Roy have no conflicts of interest that are directly relevant to the content of this review.

Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Supplementary material

40279_2019_1120_MOESM1_ESM.docx (17 kb)
Table S1 Explanations for quality assessment (DOCX 17 kb)
40279_2019_1120_MOESM2_ESM.docx (61 kb)
Table S2 Risk of bias assessment (DOCX 61 kb)
40279_2019_1120_MOESM3_ESM.docx (108 kb)
Table S3 Extracted data of included studies (DOCX 108 kb)

References

  1. 1.
    Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363–70.CrossRefGoogle Scholar
  2. 2.
    Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8:141–50.CrossRefGoogle Scholar
  3. 3.
    Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with ACL injury. Part I: outcomes. Am J Sports Med. 2008;36:40–7.CrossRefGoogle Scholar
  4. 4.
    Feucht MJ, Cotic M, Saier T, Minzlaff P, Plath JE, Imhoff AB, et al. Patient expectations of primary and revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24:201–7.CrossRefGoogle Scholar
  5. 5.
    Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42:601–14.CrossRefGoogle Scholar
  6. 6.
    Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014;48:1543–52.CrossRefGoogle Scholar
  7. 7.
    Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44:1861–76.CrossRefGoogle Scholar
  8. 8.
    Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, et al. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42:2242–52.CrossRefGoogle Scholar
  9. 9.
    Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012;40:41–8.CrossRefGoogle Scholar
  10. 10.
    Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or surgical treatment of acl injuries: knee function, sports participation, and knee reinjury: the Delaware-Oslo ACL cohort study. J Bone Joint Surg Am. 2014;96:1233–41.CrossRefGoogle Scholar
  11. 11.
    Rowe GC, Safdar A, Arany Z. Running forward: new frontiers in endurance exercise biology. Circulation. 2014;129:798–810.CrossRefGoogle Scholar
  12. 12.
    Cascio BM, Culp L, Cosgarea AJ. Return to play after anterior cruciate ligament reconstruction. Clin Sports Med. 2004;23(395–408):ix.Google Scholar
  13. 13.
    Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med. 2004;34:269–80.CrossRefGoogle Scholar
  14. 14.
    Karanikas K, Arampatzis A, Brüggemann GP. Motor task and muscle strength followed different adaptation patterns after anterior cruciate ligament reconstruction. Eur J Phys Rehabil Med. 2009;45:37–45.Google Scholar
  15. 15.
    Pratt KA, Sigward SM. Knee loading deficits during dynamic tasks in individuals following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2017;47:411–9.CrossRefGoogle Scholar
  16. 16.
    Noehren B, Abraham A, Curry M, Johnson D, Ireland ML. Evaluation of proximal joint kinematics and muscle strength following ACL reconstruction surgery in female athletes. J Orthop Res. 2014;32:1305–10.CrossRefGoogle Scholar
  17. 17.
    Herrington L, Alarifi S, Jones R. Patellofemoral joint loads during running at the time of return to sport in elite athletes with ACL reconstruction. Am J Sports Med. 2017;45:2812–6.CrossRefGoogle Scholar
  18. 18.
    Tashman S, Kolowich P, Collon D, Anderson K, Anderst W. Dynamic function of the ACL-reconstructed knee during running. Clin Orthop. 2007;454:66–73.CrossRefGoogle Scholar
  19. 19.
    Bowersock CD, Willy RW, DeVita P, Willson JD. Reduced step length reduces knee joint contact forces during running following anterior cruciate ligament reconstruction but does not alter inter-limb asymmetry. Clin Biomech. 2017;43:79–85.CrossRefGoogle Scholar
  20. 20.
    Noehren B, Wilson H, Miller C, Lattermann C. Long-term gait deviations in anterior cruciate ligament-reconstructed females. Med Sci Sports Exerc. 2013;45:1340–7.CrossRefGoogle Scholar
  21. 21.
    Pamukoff DN, Montgomery MM, Choe KH, Moffit TJ, Garcia SA, Vakula MN. Bilateral alterations in running mechanics and quadriceps function following unilateral anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2018;48:960–7.CrossRefGoogle Scholar
  22. 22.
    Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol. 2006;18:514–8.CrossRefGoogle Scholar
  23. 23.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.CrossRefGoogle Scholar
  24. 24.
    Kaur M, Ribeiro DC, Theis J-C, Webster KE, Sole G. Movement patterns of the knee during gait following ACL reconstruction: a systematic review and meta-analysis. Sports Med. 2016;46:1869–95.CrossRefGoogle Scholar
  25. 25.
    Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47:207–14.CrossRefGoogle Scholar
  26. 26.
    Schurr SA, Marshall AN, Resch JE, Saliba SA. Two-dimensional video analysis is comparable to 3d motion capture in lower extremity movement assessment. Int J Sports Phys Ther. 2017;12:163–72.Google Scholar
  27. 27.
    Dingenen B, Staes FF, Santermans L, Steurs L, Eerdekens M, Geentjens J, et al. Are two-dimensional measured frontal plane angles related to three-dimensional measured kinematic profiles during running? Phys Ther Sport. 2018;29:84–92.CrossRefGoogle Scholar
  28. 28.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Psychology Press; 2009 (reprint).Google Scholar
  29. 29.
    Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http://handbook.cochrane.org. Accessed 7 May 2019.
  30. 30.
    van Tulder M, Furlan A, Bombardier C, Bouter L, Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine. 2003;28:1290–9.Google Scholar
  31. 31.
    de Oliveira FCL, Bouyer LJ, Ager AL, Roy J-S. Electromyographic analysis of rotator cuff muscles in patients with rotator cuff tendinopathy: a systematic review. J Electromyogr Kinesiol. 2017;35:100–14.CrossRefGoogle Scholar
  32. 32.
    Kline PW, Morgan KD, Johnson DL, Ireland ML, Noehren B. Impaired quadriceps rate of torque development and knee mechanics after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 2015;43:2553–8.CrossRefGoogle Scholar
  33. 33.
    Milandri G, Posthumus M, Small TJ, Bothma A, van der Merwe W, Kassanjee R, et al. Kinematic and kinetic gait deviations in males long after anterior cruciate ligament reconstruction. Clin Biomech. 2017;49:78–84.CrossRefGoogle Scholar
  34. 34.
    Patras K, Ziogas G, Ristanis S, Tsepis E, Stergiou N, Georgoulis AD. High intensity running results in an impaired neuromuscular response in ACL reconstructed individuals. Knee Surg Sports Traumatol Arthrosc. 2009;17:977–84.CrossRefGoogle Scholar
  35. 35.
    Bohn M, Sørensen H, Petersen M, Søballe K, Lind M, Bohn MB, et al. Rotational laxity after anatomical ACL reconstruction measured by 3-D motion analysis: a prospective randomized clinical trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg Sports Traumatol Arthrosc. 2015;23:3473–81.CrossRefGoogle Scholar
  36. 36.
    Mazet A, Morin J-B, Semay B, Philippot R, Edouard P. Changes in running mechanical pattern after an anterior cruciate ligament plasty. Sci Sports. 2016;31:219–22.CrossRefGoogle Scholar
  37. 37.
    Perraton LG, Hall M, Clark RA, Crossley KM, Pua Y-H, Whitehead TS, et al. Poor knee function after ACL reconstruction is associated with attenuated landing force and knee flexion moment during running. Knee Surg Sports Traumatol Arthrosc. 2017;26:391–8.CrossRefGoogle Scholar
  38. 38.
    Saxby DJ, Bryant AL, Modenese L, Gerus P, Killen BA, Konrath J, et al. Tibiofemoral contact forces in the anterior cruciate ligament-reconstructed knee. Med Sci Sports Exerc. 2016;48:2195–206.CrossRefGoogle Scholar
  39. 39.
    Abourezk MN, Ithurburn MP, McNally MP, Thoma LM, Briggs MS, Hewett TE, et al. Hamstring strength asymmetry at 3 years after anterior cruciate ligament reconstruction alters knee mechanics during gait and jogging. Am J Sports Med. 2017;45:97–105.CrossRefGoogle Scholar
  40. 40.
    Pamukoff DN, Montgomery MM, Choe KH, Moffit TJ, Vakula MN. Effect of whole-body vibration on sagittal plane running mechanics in individuals with anterior cruciate ligament reconstruction: a randomized crossover trial. Arch Phys Med Rehabil. 2018;99:973–80.CrossRefGoogle Scholar
  41. 41.
    Lewek M, Rudolph K, Axe M, Snyder-Mackler L. The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech. 2002;17:56–63.CrossRefGoogle Scholar
  42. 42.
    Boggess G, Morgan K, Johnson D, Ireland ML, Reinbolt JA, Noehren B. Neuromuscular compensatory strategies at the trunk and lower limb are not resolved following an ACL reconstruction. Gait Posture. 2018;60:81–7.CrossRefGoogle Scholar
  43. 43.
    Kuenze C, Hertel J, Weltman A, Diduch DR, Saliba S, Hart JM. Jogging biomechanics after exercise in individuals with ACL-reconstructed knees. Med Sci Sports Exerc. 2014;46:1067–76.CrossRefGoogle Scholar
  44. 44.
    Hoshino Y, Fu FH, Irrgang JJ, Tashman S. Can joint contact dynamics be restored by anterior cruciate ligament reconstruction? Clin Orthop. 2013;471:2924–31.CrossRefGoogle Scholar
  45. 45.
    Tashman S, Collon D, Anderson K, Kolowich P, Anderst W. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:975–83.CrossRefGoogle Scholar
  46. 46.
    Bush-Joseph CA, Hurwitz DE, Patel RR, Bahrani Y, Garretson R, Bach BR Jr, et al. Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon. Am J Sports Med. 2001;29:36–41.CrossRefGoogle Scholar
  47. 47.
    Patras K, Zampeli F, Ristanis S, Tsepis E, Ziogas G, Stergiou N, et al. Hamstring-dominant strategy of the bone-patellar tendon-bone graft anterior cruciate ligament-reconstructed leg versus quadriceps-dominant strategy of the contralateral intact leg during high-intensity exercise in male athletes. Arthroscopy. 2012;28:1262–70.CrossRefGoogle Scholar
  48. 48.
    Swanik CB, Lephart SM, Giraldo JL, DeMont RG, Fu FH. Reactive muscle firing of anterior cruciate ligament-injured females during functional activities. J Athl Train. 1999;34:121–9.Google Scholar
  49. 49.
    Noehren B, Abraham A, Curry M, Johnson D, Ireland ML. Evaluation of proximal joint kinematics and muscle strength following ACL reconstruction surgery in female athletes. J Orthop Res. 2014;32:1305–10.CrossRefGoogle Scholar
  50. 50.
    Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, et al. Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010;38:1968–78.CrossRefGoogle Scholar
  51. 51.
    Sigward SM, Lin P, Pratt K. Knee loading asymmetries during gait and running in early rehabilitation following anterior cruciate ligament reconstruction: a longitudinal study. Clin Biomech. 2016;32:249–54.CrossRefGoogle Scholar
  52. 52.
    Decker MJ, Torry MR, Noonan TJ, Sterett WI, Steadman JR. Gait retraining after anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 2004;85:848–56.CrossRefGoogle Scholar
  53. 53.
    Elias ARC, Harris KJ, LaStayo PC, Mizner RL. Clinical efficacy of jump training augmented with body weight support after ACL reconstruction: a randomized controlled trial. Am J Sports Med. 2018;46:1650–60.CrossRefGoogle Scholar
  54. 54.
    Gokeler A, Benjaminse A, Welling W, Alferink M, Eppinga P, Otten B. The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Phys Ther Sport. 2015;16:114–20.CrossRefGoogle Scholar
  55. 55.
    Welling W, Benjaminse A, Gokeler A, Otten B. Retention of movement technique: implications for primary prevention of ACL injuries. Int J Sports Phys Ther. 2017;12:908–20.CrossRefGoogle Scholar
  56. 56.
    Benjaminse A, Welling W, Otten B, Gokeler A. Transfer of improved movement technique after receiving verbal external focus and video instruction. Knee Surg Sports Traumatol Arthrosc. 2018;26:955–62.CrossRefGoogle Scholar
  57. 57.
    Christensen JC, Foreman KB, LaStayo PC, Marcus RL, Pelt CE, Mizner RL. Comparison of 2 forms of kinetic biofeedback on the immediate correction of knee extensor moment asymmetry following total knee arthroplasty during decline walking. J Orthop Sports Phys Ther. 2019;49:105–11.CrossRefGoogle Scholar
  58. 58.
    Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg. 2012;132:1287–97.CrossRefGoogle Scholar
  59. 59.
    Decker MJ, Torry MR, Noonan TJ, Riviere A, Sterett WI. Landing adaptations after ACL reconstruction. Med Sci Sports Exerc. 2002;34:1408–13.CrossRefGoogle Scholar
  60. 60.
    Keays SL, Bullock-Saxton JE, Newcombe P, Keays AC. The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res. 2003;21:231–7.CrossRefGoogle Scholar
  61. 61.
    Wojtys EM, Huston LJ. Longitudinal effects of anterior cruciate ligament injury and patellar tendon autograft reconstruction on neuromuscular performance. Am J Sports Med. 2000;28:336–44.CrossRefGoogle Scholar
  62. 62.
    Petschnig R, Baron R, Albrecht M. The relationship between isokinetic quadriceps strength test and hop tests for distance and one-legged vertical jump test following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 1998;28:23–31.CrossRefGoogle Scholar
  63. 63.
    Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware–Oslo ACL cohort study. Br J Sports Med. 2016;50:804–8.CrossRefGoogle Scholar
  64. 64.
    Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:302–11.CrossRefGoogle Scholar
  65. 65.
    Lepley LK, Wojtys EM, Palmieri-Smith RM. Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction. Knee. 2015;22:270–7.CrossRefGoogle Scholar
  66. 66.
    Wang X, Wang Y, Bennell KL, Wrigley TV, Cicuttini FM, Fortin K, et al. Cartilage morphology at 2–3 years following anterior cruciate ligament reconstruction with or without concomitant meniscal pathology. Knee Surg Sports Traumatol Arthrosc. 2017;25:426–36.CrossRefGoogle Scholar
  67. 67.
    Su F, Hilton JF, Nardo L, Wu S, Liang F, Link TM, et al. Cartilage morphology and T1ρ and T2 quantification in ACL-reconstructed knees: a 2-year follow-up. Osteoarthritis Cartilage. 2013;21:1058–67.CrossRefGoogle Scholar
  68. 68.
    Elsaid KA, Fleming BC, Oksendahl HL, Machan JT, Fadale PD, Hulstyn MJ, et al. Decreased lubricin concentrations and markers of joint inflammation in the synovial fluid of patients with anterior cruciate ligament injury. Arthritis Rheumatol. 2008;58:1707–15.CrossRefGoogle Scholar
  69. 69.
    Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, Whitehead TS, et al. Early patellofemoral osteoarthritis features one year after anterior cruciate ligament reconstruction: symptoms and quality of life at three years. Arthritis Care Res. 2016;68:784–92.CrossRefGoogle Scholar
  70. 70.
    Pfeiffer SJ, Spang J, Nissman D, Lalush D, Wallace K, Harkey MS, et al. Gait mechanics and T1rho MRI of tibiofemoral cartilage 6 months after ACL reconstruction. Med Sci Sports Exerc. 2019;51:630–9.CrossRefGoogle Scholar
  71. 71.
    Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43:296–302.CrossRefGoogle Scholar
  72. 72.
    Willy RW, Meardon SA, Schmidt A, Blaylock NR, Hadding SA, Willson JD. Changes in tibiofemoral contact forces during running in response to in-field gait retraining. J Sports Sci. 2016;34:1602–11.CrossRefGoogle Scholar
  73. 73.
    Willy RW, Halsey L, Hayek A, Johnson H, Willson JD. Patellofemoral joint and achilles tendon loads during overground and treadmill running. J Orthop Sports Phys Ther. 2016;46:664–72.CrossRefGoogle Scholar
  74. 74.
    Riley PO, Dicharry J, Franz J, Croce UD, Wilder RP, Kerrigan DC. A kinematics and kinetic comparison of overground and treadmill running. Med Sci Sports Exerc. 2008;40:1093–100.CrossRefGoogle Scholar
  75. 75.
    Sinclair J. Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running. Clin Biomech. 2014;29:395–9.CrossRefGoogle Scholar
  76. 76.
    Urbach D, Nebelung W, Weiler HT, Awiszus F. Bilateral deficit of voluntary quadriceps muscle activation after unilateral ACL tear. Med Sci Sports Exerc. 1999;31:1691–6.CrossRefGoogle Scholar
  77. 77.
    Sanford BA, Zucker-Levin AR, Williams JL, Mihalko WM, Jacobs EL. Principal component analysis of knee kinematics and kinetics after anterior cruciate ligament reconstruction. Gait Posture. 2012;36:609–13.CrossRefGoogle Scholar
  78. 78.
    Henriksson M, Ledin T, Good L. Postural control after anterior cruciate ligament reconstruction and functional rehabilitation. Am J Sports Med. 2001;29:359–66.CrossRefGoogle Scholar
  79. 79.
    Hiemstra LA, Webber S, MacDonald PB, Kriellaars DJ. Contralateral limb strength deficits after anterior cruciate ligament reconstruction using a hamstring tendon graft. Clin Biomech. 2007;22:543–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityCanada
  2. 2.Department of Rehabilitation, Faculty of MedicineLaval UniversityQuebec CityCanada
  3. 3.School of Physical Therapy and Rehabilitation SciencesUniversity of MontanaMissoulaUSA

Personalised recommendations