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Pairot de Fontenay B1, Willy R2, Elias A2, Mizner R2, Roy J-S1
1Laval University, CIRRIS, Quebec, Canada, 2The University of Montana, School of Physical Therapy and Rehabilitation Science, Missoula, United States
Background: A safe return to running is critical to the clinical success of any athlete who wishes to return to sport after anterior cruciate ligament reconstruction (ACL-R). Running is a basic tenant of modern rehabilitation programs and field and court sports require running. Knowledge of specific deficits in running is required for restoring normal biomechanical limb performance during running.
Purpose: The aim of this systematic review and pooled-analysis is to compare kinetic variables of the injured leg (ACL-R) of patients who had a ACL-R from short-term (0-6 months) to mid- (6-12 months) and long-terms (more than 12 months) after surgery with uninjured peers.
Methods: PubMed, Embase, SPORTDiscus and CINAHL databases were searched from inception to December 15, 2017. The following inclusion criteria were applied based on PICOS: (P) male and female who had undergone ACL-R (any type of graft) after isolated ACL injury or in addition to meniscus and/or collateral ligament injury, (I) assessment of running gait, (C) comparison with uninjured peers (Control), (O) studies reporting kinetic data (internal knee extension moment (iKEM), internal knee abduction moment and knee joint contact forces), and (S) observational studies. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined.
Results: Of 1,819 papers identified, 5 were included. Pooled analysis of peak iKEM during running in ACL-R versus Control (3LR and 1HR studies; I2= 0%, p=0.80) showed strong evidence that peak iKEM at mid- and long-terms after ACL-R was reduced in ACL-R versus Control with a large ES (ES: -0.76, 95% CI: -0.99 to -0.53). Moderate evidence indicated that peak internal knee abduction moment during running was not different between ACL-R and Control (1LR and 1HR studies). Limited evidence indicated a significantly increased patellofemoral joint contact force at peak iKEM during running in ACL-R compared to Control in the mid-terms after surgery (1LR study). Limited evidence indicated significantly reduced peak total and peak medial tibiofemoral joint contact forces during running, and no difference for the peak lateral tibiofemoral joint contact force in ACL-R compared to Control in the long-term after ACL-R (1LR study).
Conclusion(s): The results of this systematic review identify kinetic alterations during running that are common in individuals post-ACL-R when compared to uninjured peers. Peak iKEM appeared to be the most affected parameter during running after ACL-R even long after surgery.
Implications: Clinicians should be aware of the kinetic alterations during running after ACL-R identified in this systematic review. Specifically, targeted interventions to increase iKEM may be required as iKEM deficit do not appear to resolve with time after ACL-R.
Keywords: Gait, biomechanics, knee osteoarthritis
Funding acknowledgements: None
Purpose: The aim of this systematic review and pooled-analysis is to compare kinetic variables of the injured leg (ACL-R) of patients who had a ACL-R from short-term (0-6 months) to mid- (6-12 months) and long-terms (more than 12 months) after surgery with uninjured peers.
Methods: PubMed, Embase, SPORTDiscus and CINAHL databases were searched from inception to December 15, 2017. The following inclusion criteria were applied based on PICOS: (P) male and female who had undergone ACL-R (any type of graft) after isolated ACL injury or in addition to meniscus and/or collateral ligament injury, (I) assessment of running gait, (C) comparison with uninjured peers (Control), (O) studies reporting kinetic data (internal knee extension moment (iKEM), internal knee abduction moment and knee joint contact forces), and (S) observational studies. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined.
Results: Of 1,819 papers identified, 5 were included. Pooled analysis of peak iKEM during running in ACL-R versus Control (3LR and 1HR studies; I2= 0%, p=0.80) showed strong evidence that peak iKEM at mid- and long-terms after ACL-R was reduced in ACL-R versus Control with a large ES (ES: -0.76, 95% CI: -0.99 to -0.53). Moderate evidence indicated that peak internal knee abduction moment during running was not different between ACL-R and Control (1LR and 1HR studies). Limited evidence indicated a significantly increased patellofemoral joint contact force at peak iKEM during running in ACL-R compared to Control in the mid-terms after surgery (1LR study). Limited evidence indicated significantly reduced peak total and peak medial tibiofemoral joint contact forces during running, and no difference for the peak lateral tibiofemoral joint contact force in ACL-R compared to Control in the long-term after ACL-R (1LR study).
Conclusion(s): The results of this systematic review identify kinetic alterations during running that are common in individuals post-ACL-R when compared to uninjured peers. Peak iKEM appeared to be the most affected parameter during running after ACL-R even long after surgery.
Implications: Clinicians should be aware of the kinetic alterations during running after ACL-R identified in this systematic review. Specifically, targeted interventions to increase iKEM may be required as iKEM deficit do not appear to resolve with time after ACL-R.
Keywords: Gait, biomechanics, knee osteoarthritis
Funding acknowledgements: None
Topic: Musculoskeletal: lower limb; Sport & sports injuries
Ethics approval required: No
Institution: CIRRIS
Ethics committee: IRDPQ
Reason not required: Systematic review
All authors, affiliations and abstracts have been published as submitted.
