Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: One or more of the authors has declared the following potential conflict of interest or source of funding: The Delaware-Oslo ACL Cohort was funded by grant number 5R37 HD 037985, and the MOON ACL cohort was partially funded by grant number 5R01 AR053684 (to K.P.S.) from the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases. The project was also supported by the Vanderbilt Sports Medicine Research Fund. Vanderbilt Sports Medicine received unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopaedics. M.J.A. is a paid consultant for Smith & Nephew. L.E. is a paid consultant and receives royalties and research support from Arthrex Inc, receives research support from Biomet and Smith & Nephew, and has stock or stock options in iBalance. K.P.S. has received NIH funding as well as unrestricted educational gifts from Smith & Nephew Endoscopy and DonJoy Orthopaedics and is a paid consultant for Mitek and the Cytori-Scientific Advisory Board. L.S.-M. has received NIH funding. 11. Clin Biomech (Bristol). 2002 May;17(4):274-85. doi: 10.1016/s0268-0033(02)00016-5. Gait mechanics in chronic ACL deficiency and subsequent repair. Ferber R(1), Osternig LR, Woollacott MH, Wasielewski NJ, Lee JH. Author information: (1)Department of Physical Therapy, University of Delaware, 301 McKinly Lab, Newark, DE 19716-2591, USA. reedferb@udel.edu OBJECTIVE: To determine how normal gait patterns may change as a result of chronic anterior cruciate ligament deficiency and subsequent reconstructive surgery. DESIGN: Gait testing of 10 chronic anterior cruciate ligament deficient subjects prior to and 3 months following reconstructive surgery, and 10 uninjured controls. BACKGROUND: There is controversy whether persons with chronic anterior cruciate ligament deficiency develop a "quadriceps avoidance" pattern and how anterior cruciate ligament reconstructive surgery influences gait mechanics in these same individuals. METHODS: Gait analysis was employed to determine kinematic, kinetic, and muscle Electromyographic data. RESULTS: Prior to surgery, no anterior cruciate ligament deficient subject exhibited a quadriceps avoidance pattern. Following surgery, the subjects exhibited a significantly greater knee extensor moment during early stance as compared to the control group. Prior to and following surgery, anterior cruciate ligament deficient subjects demonstrated a significantly greater hip extensor moment possibly to reduce anterior tibial translation. CONCLUSIONS; These data suggest that (1) development of a quadriceps avoidance pattern is less common than previously reported, (2) anterior cruciate ligament deficient subjects accommodate through alterations of hip joint mechanics, (3) surgical repair significantly alters lower extremity gait patterns, and (4) re-establishment of pre-injury gait patterns takes longer than 3 months to occur. RELEVANCE: The results suggest that chronic anterior cruciate ligament deficient subjects do not exhibit a quadriceps avoidance gait pattern. Surgical intervention significantly alters lower extremity gait mechanics in a population that has accommodated to anterior cruciate ligament deficiency. DOI: 10.1016/s0268-0033(02)00016-5