Gait adaptations following multiple-ligament knee reconstruction occur with altered knee kinematics during level walking

  • Corey J. Scholes
  • Joe T. Lynch
  • Milad Ebrahimi
  • Brett A. Fritsch
  • David A. Parker



The biomechanical behaviour of the knee following multiple-ligament reconstruction (MLKR) may play a role in the pathogenesis of post-traumatic osteoarthritis. The aim of this study was to compare three-dimensional knee kinematics and gait characteristics of MLKR patients to healthy controls during level walking.


Three-dimensional optoelectronic motion capture during overground walking was performed on 16 patients with MLKR and a group of healthy controls matched individually to each patient for age, gender, height and weight. Three-dimensional knee angles were extracted from the weight acceptance and propulsion sub-phases of gait. Statistical analysis was performed using group-aggregated data, as well as for each patient–control pair using a single-case approach.


Although group analysis detected few differences, single-case analysis revealed significant differences for a proportion of patients for all dependent variables during weight acceptance and propulsion sub-phases of stance. These kinematic differences occurred in the context of reduced gait velocity, step length and cadence, as well as increased time spent in double support.


Patients with MLKR display abnormalities in knee kinematics during gait at an average of 4.5 years after surgery. The pattern of kinematic abnormalities appears individual specific and may not be related to differences in spatiotemporal gait characteristics. The current findings describe detailed functional outcomes of MLKR reconstruction at average medium-term follow-up that provide improved prognostic information for clinicians to counsel patients with these types of injuries.


Gait Knee Multiple-ligament reconstruction Single-case Variability Stance 



The authors wish to acknowledge the efforts of the study volunteers in participating in data collection and Mr Laurant Kang, Mrs Amy Brierley and Dr Joe Costa in patient recruitment. The authors also acknowledge the contribution of Mr Ray Patton (University of Sydney) for his technical assistance during data collection and Mr Jack Batchen during data collection and analysis, as well as Dr Myles Coolican and Prof Richard Smith (University of Sydney) for their contribution to resourcing the project and Dr Michael Cole for his contributions to an earlier version of the manuscript. Dr Corey J. Scholes received the Brendon Dooley‐Gordon Trinca Trauma Scholarship from the Royal Australasian College of Surgeons in relation to this work, with additional financial and in-kind support provided by the Sydney Orthopaedic Research Institute.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interests to declare.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Corey J. Scholes
    • 1
  • Joe T. Lynch
    • 1
  • Milad Ebrahimi
    • 1
  • Brett A. Fritsch
    • 1
  • David A. Parker
    • 1
  1. 1.Sydney Orthopaedic Research InstituteChatswoodAustralia

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