Abstract
Matrix metalloproteinase-3 (MMP-3) is a degenerative enzyme associated with joint tissue breakdown and has been shown to be a potential biomarker of osteoarthritis. It remains unknown if synovial fluid (SF) MMP-3 concentrations following ACL injury influence gait mechanics. PURPOSE: To compare knee flexion angle (KFA) and internal knee extension moment (KEM) during gait 6 months post-ACLR in individuals with the highest concentrations of SF MMP-3 compared to those with the lowest concentrations of SF MMP-3 collected within the first 14 days of injury. METHODS: Thirty-seven individuals with ACL injury scheduled for primary patellar tendon autograft ACLR (57% females, 21±4 yrs, 23.7±2.8 BMI) participated. Individuals were grouped into highest (HQ; n=9) and lowest (LQ; n=10) quartiles based on MMP-3 knee joint SF concentrations sampled 6+4 days after ACL injury. At 6 months post-ACLR, biomechanics were collected using 3-dimensional motion capture during gait performed at a self-selected speed. Functional analyses of variance were conducted to compare KFA and KEM between HQ and LQ groups throughout stance. Groups were considered different at any percentage of stance where the 95% confidence intervals of the mean differences did not cross zero. Peak differences (PD) and corresponding effect sizes (Cohen’s d) within portions of stance demonstrating differences were also calculated. RESULTS: HQ exhibited lesser knee flexion excursion; KFA was lower during 17-24% of stance (PD: 2.1°, d=0.44) and greater during 48-100% of stance (PD: 4.5°, d=0.93). HQ also exhibited lower KEM during 14-30% and 91-100% of stance (PD: 0.72 BW, d=0.67; PD: 0.33 BW, d=1.42) and greater KEM during 45-72% of stance (PD: 0.44, d=0.76) CONCLUSION: Compared to individuals in the lowest quartile of SF MMP-3, those in the highest exhibited a stiffened knee gait strategy. Pre-surgery levels of MMP-3 following ACL injury may serve as a biomarker predicting worse gait mechanics 6 months post-ACLR.
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