Skip to main content


Log in

Gait patterns before and after anterior cruciate ligament reconstruction

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


The aim of this study is to determine how selected gait parameters may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was performed on 25 ACL-deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months after ACL reconstructive surgery by the bone-patellar tendon-bone technique. Gait analysis was performed using the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris Medizintechnik GmbH, Germany). Kinematic data were recorded for the lower limb. The muscles examined include vastus lateralis and medialis, biceps femoris and adductor longus. The results obtained from the injured subjects were compared with those of 51 individuals without ACL damage. The acute ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks after surgery. The quadriceps avoidance phenomenon does not develop in chronic ACL-deficient patients. In the individuals operated on, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient limb during gait 4 months after surgery. However, the relative ACL movement parameter—which describes the tibial translation into the direction of ACL—and the EMG traces show no significant statistical difference compared with the values of healthy control group just 8 months after surgery. The results suggest that: (1) development of a quadriceps avoidance pattern is less common than previously reported, (2) anterior cruciate ligament deficiency and reconstruction significantly alter the lower extremity gait pattern, (3) the gait parameters shift towards the normal value pattern, and (4) the re-establishment of pre-injury gait patterns—including the normal biphase of muscles—takes at least 8 months to occur.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5a–d

Similar content being viewed by others


  1. Alton F, Baldey L, Caplan S, Morrissey MC (1998) A kinematic comparison of over ground and treadmill walking. Clinical Biomech 13:434–440

    Article  Google Scholar 

  2. Andriacchi TP (1993) Functional analysis of pre and post knee surgery; total knee arthrosplasty and ACL reconstruction. J. Biomech Eng 115:575–581

    CAS  PubMed  Google Scholar 

  3. Andriacchi TP, Birac D (1993) Functional testing in the anterior cruciate ligament-deficient knee. Clin Orthop 288:40–47

    PubMed  Google Scholar 

  4. Berchuck M, Andriacchi TP, Bach BR, Reider BR (1990) Gait adaptations by patients who have a deficient ACL. J Bone Joint Surg Am 72:871–877

    CAS  PubMed  Google Scholar 

  5. Birac RC, Andriacchi TP, Bach BR (1991) Time related changes following ACL rupture. Trans Orthop Res Soc 1:231

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  7. Bush-Joseph CA, Hurwitz DE, Patel RR, Bahrani Y, Garretson R, Bach BR et al (2001) Dynamic function after anterior cruciate ligament reconstruction with autologous patellar tendon. Am J Sports Med 29:36–41

    CAS  Google Scholar 

  8. Ciccotti MG, Kerlan RK, Perry J, Pink M (1995) 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

    Google Scholar 

  9. Devita P, Hortobagyi T, Barrier J (1997) Gait adaptations before and after anterior cruciate ligament reconstruction surgery. Med Sci Sport Exerc 29:853–859

    CAS  Google Scholar 

  10. Devita P, Hortobagyi T, Barrier J (1998) Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation. Med Sci Sport Exerc 30:1481–1488

    CAS  Google Scholar 

  11. Ernst GP, Saliba E, Diduch DR, Hurwitz SR, Ball DW (2000) Lower extremity compensations following anterior cruciate ligament reconstruction. Phys Ther 80:251–259

    CAS  PubMed  Google Scholar 

  12. Hurwitz DE, Andriacchi TP, Bush-Joseph CA, Bach BR (1997) Functional adaptations in patients with ACL-deficient knee. Exerc Sport Sci Rev 25:1-20

    CAS  PubMed  Google Scholar 

  13. Imran A, O’Connor JJ (1998) Control of knee stability after ACL injury or repair: interaction between hamstrings contraction and tibial translation Clin Biomech 13:153–162

    Google Scholar 

  14. Knoll Zs, Kocsis L, Kiss RM (2002) Gait mechanics of chronic ACL-deficient knee. Sixth International Conference Orthopaedics, Biomechanics, Sports Rehabilitation, Assisi, Italy, 22–24 November 2002, pp 135–139

  15. Kocsis L, Knoll Zs, Kiss R (2003) Joint kinematics and spatial-temporal parameters of gait measured by an ultrasound-based system. J Biomech (in press)

  16. Lafortune MA, Cavanagh PA, Sommer HJ, Kalenka A (1992) Three-dimensional kinematics of the human knee during walking. J Biomech 25:347–357

    CAS  PubMed  Google Scholar 

  17. Matsas A, Taylor N, McBurney H (2000) Knee joint kinematics from familiarized treadmill walking can be generalized to over ground walking in young unimpaired subjects. Gait Posture 11:46–53

    CAS  PubMed  Google Scholar 

  18. Noyes FR, Matthews DS, Mooar PA, Grood ES (1983) The symptomatic anterior cruciate deficient knee. J Bone Joint Surg Am 65:163–174

    CAS  PubMed  Google Scholar 

  19. Osternig LR, Ferber R, Mercer J, Davis HP (2000) Human hip and knee torque accommodation to anterior cruciate ligament dysfunction. Eur J Appl Physiol 83:71–76

    CAS  PubMed  Google Scholar 

  20. Pandy MG, Shelburne KB (1997) Dependence of cruciate ligament and extensor mechanism function in the ACL deficient knee. Clin Biomech 13:98–111

    Article  Google Scholar 

  21. 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 10:189–199

    Article  CAS  PubMed  Google Scholar 

  22. Rudolph KS, Eastlack ME, Axe MJ, Snyder-Mackler L (1998) 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 

  23. Timoney JM, Inman WS, Quesada PM, Sharkey PF, Barrack RL, Skinner HB et al (1993) Return of normal gait patterns after anterior cruciate ligament reconstruction. Am J Sports Med 21:887–889

    CAS  PubMed  Google Scholar 

  24. Vaughan CL, Davis BL, O’Connor JC (1999) Dynamics of human gait. Kiboho, Cape Town

  25. Wexler G, Hurwitz DE, Bush-Joseph CA, Andriacchi TP, Bach BR (1998) Functional gait adaptations in patients with anterior cruciate ligament deficiency over time. Clin Orthop 348:166–175

    PubMed  Google Scholar 

Download references


This work was supported in part by the Hungarian Scientific Fund T034130 and T037272, by Stipendium István Széchenyi (Rita Kiss, László Kocsis) and by MEDICaMENTOR Foundation. The paper is dedicated to Professor George Springer for his support and guidance.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Rita M. Kiss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knoll, Z., Kocsis, L. & Kiss, R.M. Gait patterns before and after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12, 7–14 (2004).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: