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Poor knee function after ACL reconstruction is associated with attenuated landing force and knee flexion moment during running

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

Abstract

Purpose

Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in individuals following ACLR.

Methods

61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb). Participants were divided into satisfactory and poor knee function groups (poor < 85% patient-reported knee function and/or < 85% hop test symmetry). The knee biomechanics of both groups were assessed with three-dimensional motion analysis during the stance phase of overland running at self-selected speeds, and the association between knee function and knee moments was assessed using analysis of covariance with running speed as a covariate.

Results

Participants with poor knee function (n = 30) ran with significantly smaller peak knee flexion moments (moderate effect size 0.7, p = 0.03) and significantly smaller peak vGRFs (large effect size 1.0, p = 0.002) compared to those with satisfactory knee function (n = 31). No significant differences were observed for knee adduction and knee external rotation moments or knee kinematics.

Conclusion

Individuals following ACLR with poor self-reported knee function and/or hop test performance demonstrate knee moments during running that may be associated with lower knee joint contact forces. These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function.

Level of evidence

III. Cross-sectional study.

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Acknowledgements

We gratefully acknowledge the assistance of Ms. Stacey Telianidis and Ms. Karine Fortin who assisted with data collection. Luke Perraton was a recipient of a National Health and Medical Research Council (NHMRC) postgraduate scholarship (APP1038378). Michelle Hall is supported by a Sir Randal Heymanson Research Fellowship from The University of Melbourne. Adam Bryant and Ross Clark are recipients of NHMRC Career Development Fellowships (R.D.Wright Biomedical, no. 1053521 and 1090415). AC was supported by postdoctoral funding from a European Union Seventh Framework Program (FP7-PEOPLE-2013-ITN; 607510) and is a recipient of an NHMRC Early Career Fellowship (Neil Hamilton Fairley, no. 1121173). The authors have no professional or financial affiliations that may be perceived to have biased the presentation.

Author information

Authors and Affiliations

  1. Department of Physiotherapy, School of Primary Health Care, Monash University, Building B, McMahons Road, Peninsula campus, Frankston, VIC, 3199, Australia

    Luke G. Perraton

  2. Melbourne School of Physiotherapy, The University of Melbourne, Melbourne, Australia

    Luke G. Perraton, Michelle Hall & Adam L. Bryant

  3. School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Australia

    Ross A. Clark

  4. School of Allied Health, La Trobe University, Bundoora, Australia

    Kay M. Crossley & Adam G. Culvenor

  5. Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore

    Yong-Hao Pua

  6. Orthosport Victoria, Epworth Hospital, Melbourne, Australia

    Tim S. Whitehead

  7. The Park Clinic, Melbourne, Australia

    Hayden G. Morris

  8. Institute of Anatomy Salzburg and Nuremburg, Paracelsus Medical University, Salzburg, Austria

    Adam G. Culvenor

Authors
  1. Luke G. Perraton
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  2. Michelle Hall
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Corresponding author

Correspondence to Luke G. Perraton.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There was no external source of funding for this study.

Ethical approval

Ethical approval was obtained by the University of Melbourne Human Research Ethics committee (ID 1136167). All procedures performed were in accordance with the ethical standards of the institution and the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Perraton, L.G., Hall, M., Clark, R.A. 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 26, 391–398 (2018). https://doi.org/10.1007/s00167-017-4810-5

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  • DOI: https://doi.org/10.1007/s00167-017-4810-5

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