Skip to main content
SpringerLink
Log in

Interjoint coordination in lower limbs in patients with a rupture of the anterior cruciate ligament of the knee joint

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

Abstract

Previous studies of movement kinematics in patients with a ruptured anterior cruciate ligament (ACL) have focused on changes in angular displacement in a single joint, usually flexion/extension of the knee. In the present study, we investigated the effect of an ACL injury on the overall limb interjoint coordination. We asked healthy and chronic ACL-deficient male subjects to perform eight types of movements: forward squats, backward squats, sideways squats, squats on one leg, going up a step, going down a step, walking three steps, and stepping in place. Depending on the movement concerned, we applied principal component (PC) analysis to 3 or 4 degrees of freedom (DFs): thigh flexion/extension, knee flexion/extension, ankle flexion/extension, thigh abduction/adduction. The first three DFs were investigated in all movements. PC analysis identifies linear combinations of DFs. Movements with a fixed ratio between DFs are thus described by only one PC or synergy. PCs were computed for the entire movement as well as for the period of time when the foot was in contact with the ground. For both the control and the injured groups, two synergies (PC vectors) usually accounted for more than 95% of the DFs’ angular excursions. It was possible to describe 95–99% of some movements using only one synergy. Compared to control subjects, injured subjects employed different synergies for going up a step, walking three steps, squatting sideways, and squatting forward, both in the injured and uninjured legs. Those movements may thus be more indicative of injury than other movements. Although ACL-deficiency did not increase asymmetry (angle between the PCs of the same movement performed on the right and the left sides), this result is not conclusive because of the comparatively low number of subjects who participated in the study. However, the finding that synergies in both legs of patients were different from those in control subjects for going up a step and walking three steps suggests that interjoint coordination was affected for both legs, so that the asymmetry index might have been preserved despite the injury. There was also a relationship between the asymmetry index for squatting on one leg, squatting forward, walking three steps and some of the outcomes of the knee injury and osteoarthritis outcome score (pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life). This suggests that significant differences in the asymmetry index could be obtained if more severely-injured patients participated in this study. It is possible that subjects compensated for their mechanical deficiencies by modifying muscle activation patterns. Synergies were not only modified in injured subjects, but also rearranged: the percentage of movement explained by the first PC was different for the injured and/or uninjured legs of patients, as compared to the legs of the control group, for going up a step, going down a step, walking three steps, and squatting forward. We concluded that the analysis of interjoint coordination may be efficient in characterizing motor deficits in people with knee injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2a, b
Fig. 3a, b
Fig. 4a, b
Fig. 5a, b
Fig. 6
Fig. 7a, b
Fig. 8a, b
Fig. 9a–d
Fig. 10

Similar content being viewed by others

References

  1. Ahmed AM, Hyder A, Burke DL, Chan KH (1987) In vitro ligament tension pattern in the flexed knee in passive loading. J Orthop Res 5:217–230

    PubMed  Google Scholar 

  2. Alexandrov A, Frolov A, Massion J (1998) Axial synergies during human upper trunk bending. Exp Brain Res 118:210–220

    CAS  PubMed  Google Scholar 

  3. Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop 172:19–25

    PubMed  Google Scholar 

  4. Bach JM, Hull ML (1998) Strain inhomogeneity in the anterior cruciate ligament under application of external and muscular loads. J Biomech Eng 120:497–503

    PubMed  Google Scholar 

  5. Beard DJ, Soundarapandian RS, O’Connor JJ, Dodd CAF (1996) Gait and electromyographic analysis of anterior cruciate ligament deficient subjects. Gait Posture 4:83–88

    Article  Google Scholar 

  6. Berns GS, Hull ML, Patterson HA (1992) Strain in the anteromedial bundle of the anterior cruciate ligament under combination loading. J Orthop Res 10:167–176

    PubMed  Google Scholar 

  7. Boerboom AL, Hof AL, Halbertsma JP, van Raaij JJ, Schenk W, Diercks RL, van Horn JR (2001) Atypical hamstrings electromyographic activity as a compensatory mechanism in anterior cruciate ligament deficiency. Knee Surg Sports Traumatol Arthrosc 9:211–216

    Google Scholar 

  8. Branch TP, Hunter R, Donath M (1989) Dynamic EMG analysis of anterior cruciate deficient legs with and without bracing during cutting. Am J Sports Med 17:35–41

    CAS  PubMed  Google Scholar 

  9. Bulgheroni P, Bulgheroni MV, Andrini L, Guffanti P, Giughello A (1997) Gait patterns after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 5:14–21

    CAS  PubMed  Google Scholar 

  10. Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 62:259–270

    CAS  PubMed  Google Scholar 

  11. 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 22:651–658

    PubMed  Google Scholar 

  12. 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 29:853–859

    CAS  PubMed  Google Scholar 

  13. Gauffin H, Tropp H (1992) Altered movement and muscular-activation patterns during the one-legged jump in patients with an old anterior cruciate ligament rupture. Am J Sports Med 20:182–192

    CAS  PubMed  Google Scholar 

  14. Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144

    CAS  PubMed  Google Scholar 

  15. Grood ES, Suntay WJ, Noyes FR, Butler DL (1984) Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am 66:725–734

    PubMed  Google Scholar 

  16. Hsieh HH, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am 58:87–93

    CAS  PubMed  Google Scholar 

  17. Johnson RA, Wichern DW (1988) Applied multivariate statistical analysis. Prentice Hall, New Jersey

  18. Kuster M, Sakurai S, Wood GA (1995) The anterior cruciate ligament-deficient knee: compensatory mechanisms during downhill walking. Knee 2:105–111

    Article  Google Scholar 

  19. Kvist J, Gillquist J (2001) Anterior positioning of tibia during motion after anterior cruciate ligament injury. Med Sci Sports Exerc 33:1063–1072

    PubMed  Google Scholar 

  20. Lass P, Kaalund S, leFevre S, Arendt-Nielsen L, Sinkjaer T, Simonsen O (1991) Muscle coordination following rupture of the anterior cruciate ligament. Electromyographic studies of 14 patients. Acta Orthop Scand 62:9–14

    CAS  PubMed  Google Scholar 

  21. Limbird TJ, Shiavi R, Frazer M, Borra H (1988) EMG profiles of knee joint musculature during walking: changes induced by anterior cruciate ligament deficiency. J Orthop Res 6:630–638

    PubMed  Google Scholar 

  22. Lipke JM, Janecki CJ, Nelson CL, McLeod P, Thompson C, Thompson J, Haynes DW (1981) The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am 63:954–960

    PubMed  Google Scholar 

  23. Mah CD, Hulliger M, Lee RG, O’Callaghan IS (1994) Quantitative analysis of human movement synergies: constructive pattern analysis for gait. J Mot Behav 26:83–102

    Google Scholar 

  24. Marans HJ, Jackson RW, Glossop ND, Young C (1989) Anterior cruciate ligament insufficiency: a dynamic three-dimensional motion analysis. Am J Sports Med 17:325–332

    CAS  PubMed  Google Scholar 

  25. Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JL (1995) Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res 13:930–935

    PubMed  Google Scholar 

  26. McNair PJ, Marshall RN, Matheson JA (1989) Gait of subjects with anterior cruciate ligament deficiency. Clin Biomech 4:243–248

    Google Scholar 

  27. More RC, Karras BT, Neiman R, Fritschy D, Woo SL, Daniel DM (1993) Hamstrings—an anterior cruciate ligament protagonist. An in vitro study. Am J Sports Med 21:231–237

    CAS  PubMed  Google Scholar 

  28. Muneta T, Ogiuchi T, Imai S, Ishida A (1998) Measurements of joint moment and knee flexion angle of patients with anterior cruciate ligament deficiency during level walking and on one leg hop. Biomed Mater Eng 8:207–218

    PubMed  Google Scholar 

  29. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    PubMed  Google Scholar 

  30. Rudolph KS, Axe MJ, Buchanan TS, Scholz JP, Snyder-Mackler L (2001) Dynamic stability in the anterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc 9:62–71

    Google Scholar 

  31. Rudolph KS, Axe MJ, Snyder-Mackler L (2000) Dynamic stability after ACL injury: who can hop? Knee Surg Sports Traumatol Arthrosc 8:262–269

    Google Scholar 

  32. Rudolph KS, Eastlack ME, Axe MJ, Snyder-Mackler L (1998) 1998 Basmajian student award paper. Movement patterns after anterior cruciate ligament injury: a comparison of patients who compensate well for the injury and those who require operative stabilization. J Electromyogr Kinesiol 8:349–362

    PubMed  Google Scholar 

  33. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293

    CAS  PubMed  Google Scholar 

  34. Santello M, Flanders M, Soechting JF (1998) Postural hand synergies for tool use. J Neurosci 18:10105–10115

    CAS  PubMed  Google Scholar 

  35. Shiavi R, Limbird T, Borra H, Edmondstone MA (1991) Electromyography profiles of knee joint musculature during pivoting: changes induced by anterior cruciate ligament deficiency. J Electromyogr Kinesiol 1:49–57

    Google Scholar 

  36. Shiavi R, Limbird T, Frazer M, Stivers K, Strauss A, Abramovitz J (1987) Helical motion analysis of the knee—II. Kinematics of uninjured and injured knees during walking and pivoting. J Biomech 20:653–665

    PubMed  Google Scholar 

  37. St-Onge N, Feldman AG (2003) Interjoint coordination in lower limbs during different movements in humans. Exp Brain Res 148:139–149

    PubMed  Google Scholar 

  38. Tibone JE, Antich TJ, Fanton GS, Moynes DR, Perry J (1986) Functional analysis of anterior cruciate ligament instability. Am J Sports Med 14:276–284

    CAS  PubMed  Google Scholar 

  39. Vernazza-Martin S, Martin N, Massion J (1999) Kinematic synergies and equilibrium control during trunk movement under loaded and unloaded conditions. Exp Brain Res 128:517–526

    Article  CAS  PubMed  Google Scholar 

  40. 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 348:166–175

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. T. Heron for helping in recruiting patients. The study was supported by a research operating grant from Canadian Institutes of Health Research (Canada) and by a grant for graduate students from Natural Sciences and Engineering Research Council of Canada (Canada).

Author information

Authors and Affiliations

  1. Rehabilitation Institute of Montreal, 6300 Darlington Avenue, Montréal, Québec, H3S 2J4, Canada

    N. St-Onge & A. G. Feldman

  2. GRBB, Polytechnique, Centre-ville Station, P.O. Box 6079, Montréal, Québec, H3C 3A7, Canada

    N. St-Onge, N. Duval & L’H. Yahia

  3. LIO, Notre-Dame Hospital, CHUM, 1560 Sherbrooke St. E., Montréal, Québec, H2L 4M1, Canada

    N. St-Onge, N. Duval & L’H. Yahia

  4. Physiology Department, Montreal University, Centre-ville Station, P.O. Box 6128 , Montréal, Québec, H3C 3J7 , Canada

    A. G. Feldman

Authors
  1. N. St-Onge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Duval
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L’H. Yahia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. G. Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. St-Onge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

St-Onge, N., Duval, N., Yahia, L. et al. Interjoint coordination in lower limbs in patients with a rupture of the anterior cruciate ligament of the knee joint. Knee Surg Sports Traumatol Arthrosc 12, 203–216 (2004). https://doi.org/10.1007/s00167-003-0420-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-003-0420-5

Keywords

Search

Navigation