The Effect of Anterior Cruciate Ligament Reconstruction on Long-Term Post-Traumatic Knee Osteoarthritis Risk Due to Persistent Biomechanical Loading Alterations
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2024
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Context: Persistent compensatory underloading of the knee during running may play a critical role in driving cellular and metabolic changes associated with the progression of knee OA. However, evidence of long-term running mechanics following anterior cruciate ligament reconstruction (ACLR) remains equivocal. Therefore, the purpose of this study was to investigate biomechanical loading differences during running between participants with a history of unilateral ACLR more than two years prior and healthy matched controls (CON) to determine influences that may contribute to the increased risks of PTOA development. Methods: Running biomechanics of 37 ACLR (27.0 ± 6.6yr, 1.7 ± 0.1m, 75.6 ± 21.1kg; 23 females; 8.3 ± 5.3 years post-ACLR) and 37 healthy control participants (24.6 ± 4.7yr, 1.7 ± 0.1m, 73.0 ± 20.1kg; 23 females) were evaluated. Current activity levels were evaluated with the Tegner Activity Scale (5.84 ± 1.4 ACLR, 5.73 ± 1.6 CON). Participants performed trials running at a velocity of 4.0 m/s-1 ± 10%. The ACLR limb was individually matched to CON via limb dominance. Kinematics were collected at 240Hz via 3D motion capture system (Vicon, Colorado, USA); kinetics were collected at 960Hz using a force plate (AMTI, Massachusetts, USA). Kinematic and kinetic data were smoothed using a Butterworth filter with a 10Hz cut-off frequency, except for ground reaction force which was filtered at 50 Hz, and processed using Visual 3D (C-Motion, Inc., Germantown, MD). Two-way full factorial ANOVA and t-tests were used to determine differences in gait-related variables during stance between ACLR versus their contralateral limb (CONTRA) and versus CON matched limbs.
Results: ACL limbs demonstrated decreased KFM and KFM impulse compared to healthy controls and their CONTRA limbs. ACL limbs had an increased hip adduction and hip internal rotation moment compared to healthy controls, while an increase in hip adduction and hip internal rotation power were observed compared to their CONTRA limb.
Conclusions: Persistent knee underloading was evident with lower peak KFM and KFM impulse following ACLR when compared to healthy matched controls and the CONTRA limb. The ACL limb demonstrated compensatory hip loading strategies, primarily with increased frontal and transverse plane hip moments compared to healthy controls, and with increased hip frontal and transverse plane hip powers compared to the CONTRA limb. In conjunction with knee underloading demonstrated during walking, these findings during running may contribute to and exacerbate gradual articular cartilage degeneration and the development of PTOA within 10-20 years after ACLR.
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Biomechanics, ACL, anterior cruciate ligament, athletic training, biomechanics, osteoarthritis, post-traumatic osteoarthritis
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203 pages
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