Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knees: a systematic review

Abstract

Background: Altered joint motion that occurs in people with an anterior cruciate ligament deficient (ACLD) knee has been proposed to play a role in the initiation of knee osteoarthritis (OA), although the exact mechanism behind this is poorly understood. There is evidence that frontal plane knee motion plays a crucial role in the pathogenesis of knee OA. However, limited information exists with regards to frontal and transverse plane knee kinematics and kinetics. Purpose: We aimed to identify all relevant articles and synthesize the findings of the literature on 3D gait deviations emphasising on the frontal and transverse plane in individuals with chronic ACLD knee; those who have had the injury for 6 months or longer compared to their uninjured knee or a control group. Methods: As per the PRISMA guidelines, we searched five electronic databases from inception to 14th October 2013, with key words related to ACL, biomechanics and gait, limited to human studies only. Two independent reviewers assessed study eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the STROBE statement checklist. Results: Of the 1075 identified citations, 16 studies met the inclusion criteria. The selected studies have a small sample size (range = 20–72) and a higher number of male participants compared to women (average = 69.3% men). The participants with ACLD knee had an average age of 30.4± 8.95 years and time from injury that ranged from 6 months to more than 7.5 years. Comparing the two groups (ACLD vs. healthy controls) most studies found no kinetic or kinematic differences. However, individual studies identified the following differences during the stance phase of gait with the ACLD group exhibiting: a) greater knee abduction angle at heel strike (1 out of 3 studies); b) greater tibial external rotation (2 out of 4 studies); c) greater average knee flexion angle (6 out of 11 studies); lower knee adduction moment (1 out of 3 studies) and e) greater knee extensor moment at heel strike (1 out of 7 studies) and terminal stance (1 out of 7 studies), and lower knee flexor moment at midstance (1 out of 7 studies). When comparing the two knees of the ACLD group, one study investigated the internal-external rotation kneemoment with no significant difference. Conclusion(s):There is limited and inconsistent evidence of altered knee kinematic and kinetic in the in individualswith chronicACLD;. Themost consistentfindingwas greater knee flexion during the stance phase. Implications: There is a need for more prospective studies that evaluate the gait characteristics of the chronic ACLD knee population in all planes; especially in the frontal and transverse. If consistently occurring gait deviations can be identified, it will provide insight in the initiation of knee osteoarthritis in individuals with chronic ACLD.