Sex Differences in Long-term Running Knee Loading Mechanics Between Anterior Cruciate Ligament Reconstructed and Healthy Controls

Gin, Malia Xiao

Sex Differences in Long-term Running Knee Loading Mechanics Between Anterior Cruciate Ligament Reconstructed and Healthy Controls

Files

Gin_hawii_0085O_12127.pdf (1.32 MB)

Date

2024

Authors

Gin, Malia Xiao

Advisor

Stickley, Christopher

Department

Kinesiology and Rehabilitation Science

Abstract

Context: The prevalence of anterior cruciate ligament (ACL) injuries is increasing annually in the US, with female athletes two to eight times more likely to sustain an ACL tear than their male counterparts. Long-term biomechanical alterations in loading after anterior cruciate ligament reconstruction (ACLR) likely play a critical role in cellular and metabolic responses associated with a 3-6 times increased risk of developing osteoarthritis (OA) among ACLR patients. However, differences in long-term compensatory patterns between males and females, which may contribute to the increased rate of OA in women, have not been widely studied. Thus, the purpose of this study was to compare the effect of ACLR within females versus the effect of ACLR within males. Specifically, this study evaluated differences in running knee loading mechanics within females and males with ACLR long-term relative to their sex-matched healthy controls. Methods: Running biomechanics of participants with a history of ACLR were compared to matched controls. Six successful running trials, three for each foot, with patients running at 4.0 m/s ±10% were used for analysis. Kinematic data were collected via a 3D motion capture system (Vicon, Inc., Centennial, CO) at 240 Hz and time synchronized with kinetic data collected at 960 Hz using a force plate (AMTI, Boston, MA). Kinematic and kinetic data were filtered using a Butterworth filter with a 10Hz cut-off frequency, except for ground reaction force which was filtered at 50z and processed using Visual3D (C-Motion Inc, Germantown, MD). A 2x2 factorial model was used to identify knee moments in the sagittal and frontal planes for which the effect of ACLR differed by sex. Subsequently, post-hoc pairwise comparisons were used for variables with significant interactions from the factorial model to identify differences by group (ACLR vs. CON) and sex (Male vs. Female). For comparisons that produce a significant P-value in the post hoc pairwise analysis, statistical parametric mapping (SPM) ANOVA analyses were conducted on the respective time-normalized biomechanical waveforms across the stance phase separately for each sex to further identify differences in discrete variables throughout the entire motion and contextualize discrete variable differences. Results: The effect of ACLR on peak knee adduction moment (KAM) (interaction: P=0.041, n2:0.058), the timing of KAM within stance (KAM%) (interaction: P=0.034, n2:0.063), and KAM impulse (interaction; P=0.025, n2=0.069) was significantly different by sex. KAM was significantly higher in ACLR females compared to CON females (P= 0.043, n2= 0.057). KAM% was significantly earlier during stance in ACLR females compared to CON females (P=0.012, n2:0.086). Female ACLR exhibited decreased peak absorptive sagittal knee power (P=0.002, n2:0.131) but increased peak absorptive frontal knee power (P=0.036, n2:0.061) compared to CON females. Male ACLR exhibited a significant decrease in KAM impulse (P= 0.029, n2=0.067) with no differences in female groups. Conclusion: Females, an average of 8 years following ACLR, demonstrated increases in frontal plane knee loading represented by KAM and earlier occurrence of KAM during stance compared to CON females, which indicate increased medial compartment loading and may contribute to the marked increase in OA risk following ACLR. Earlier KAM% in ACLR females suggests abnormal overloading in an area of the articular cartilage that may not be accommodated to KAM forces. Females exhibited a force absorption strategy of decreased sagittal plane absorptive power and increased frontal plane absorptive power following ACLR suggesting absorptive forces from the sagittal plane are diverted to the frontal plane. ACLR males exhibited cumulative underloading, represented by KAM impulse which may be equally detrimental and increase the risk for cartilage degeneration. Both overloading and underloading occurring long-term following ACLR present a potential risk for degeneration of cartilage health and PTOA risk.

Keywords

Kinesiology

URI

https://hdl.handle.net/10125/108478

Extent

59 pages

Rights

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Collections

M.S. - Kinesiology and Rehabilitation Science

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