Knee loading asymmetries during gait and running in early rehabilitation following anterior cruciate ligament reconstruction: A longitudinal study

Background: Normalization of gait is expected 8-12 weeks after anterior cruciate ligament reconstruction and is a criterion for progression to running. Long-term persistence of sagittal knee loading deficits suggests that early goals are not met. Magnitude and progression of deficits in gait during this time and their relationship to deficits in running are not known. Methods: 12 individuals status-post reconstruction (5 males) underwent 3-dimensional motion analysis of gait after surgery: one (T1) and three (T2) months and at initiation of running (T3); and running T3. Repeated measures ANOVAs (limb x time) assessed differences in knee flexion, extensor moment impulse and negative work in gait; paired t-tests compared limbs during running; and Pearson's correlations determined associations between limb ratios (moment and work) in gait and running. Findings: Less flexion (-4.4 (0.63) degrees; mean (SE)), 35% smaller extensor moment (-0.15 (0.006) Nm * s/kg) and 47% less work (-0.03 (0.008) J/kg) were observed in the surgical knee during gait across time. Moment and work were 1.7 (-0.1 (0.03) Nm * s/kg) and 1.6 times greater (-0.23 (0.047) J/kg) in non-surgical knee during running. Moment and work limb asymmetries correlated across time during gait (r = 0.778-0.929, P < 0.001) and to asymmetries during running. Interpretation: Limb asymmetries in knee loading present one month after reconstruction persist 4 months post reconstruction. Correlations between limb asymmetries during gait across time and to running suggest that early gait behaviors relate to longer-term loading. Greater attention should be placed on early gait training. (C) 2015 Published by Elsevier Ltd.