Lower limb coordination patterns following anterior cruciate ligament reconstruction: A longitudinal study

Cortney Armitano-Lago; Elizabeth Bjornsen; Caroline Lisee; Ashley Buck; Christin Büttner; Adam W Kiefer; Todd A Schwartz; Brian Pietrosimone

doi:10.1016/j.jshs.2024.100988

Lower limb coordination patterns following anterior cruciate ligament reconstruction: A longitudinal study

J Sport Health Sci. 2024 Sep 17:100988. doi: 10.1016/j.jshs.2024.100988. Online ahead of print.

Authors

Cortney Armitano-Lago¹, Elizabeth Bjornsen², Caroline Lisee³, Ashley Buck², Christin Büttner², Adam W Kiefer², Todd A Schwartz⁴, Brian Pietrosimone²

Affiliations

¹ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: carmitan@email.unc.edu.
² Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
³ Department of Kinesiology, University of Georgia, Athens, GA 30602, USA.
⁴ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

PMID: 39299606
DOI: 10.1016/j.jshs.2024.100988

Abstract

Background: Changes in lower limb joint coordination have been shown to increase localized stress on knee joint soft tissue-a known precursor of osteoarthritis. While 50 % of individuals who undergo anterior cruciate ligament reconstruction (ACLR) develop radiographic osteoarthritis, it is unclear how underlying joint coordination during gait changes post-ACLR. The purpose of this study was twofold: to determine differences in lower limb coordination patterns during gait in ACLR individuals 2, 4, and 6 months post-ACLR and to compare the coordination profiles of the ACLR participants at each timepoint post-ACLR to uninjured matched controls.

Methods: We conducted a longitudinal assessment to quantify lower limb coordination at 3 timepoints post-ACLR and compared the ACLR coordination profiles to uninjured controls. Thirty-four ACLR (age = 21.43 ± 4.24 years, mean ± SD; 70.59 % female) and 34 controls (age = 21.42 ± 3.43 years; 70.59 % female) participated. The ACLR group completed 3 overground gait assessments (2,4, and 6 months post-ACLR), and the controls completed 1 assessment, at which lower limb kinematics were collected. Cross-recurrence quantification analysis was used to characterize sagittal and frontal plane ankle-knee, ankle-hip, and knee-hip coordination dynamics. Comprehensive general linear mixed models were constructed to compare between-limb and within-limb coordination outcomes over time post-ACLR and a between-group comparison across timepoints.

Results: The ACLR limb demonstrated a more "stuck" sagittal plane knee-hip coordination profile (greater trapping time (TT); p = 0.004) compared bilaterally. Between groups, the ACLR participants exhibited a more predictable ankle-knee coordination pattern (percent determinism (%DET); p < 0.05), stronger coupling between joints (meanline (MNLine)) across all segments (p < 0.05), and greater knee-hip TT (more "stuck"; p < 0.05) compared to the controls at each timepoint in the sagittal plane. Stronger frontal plane knee-hip joint coupling (MNLine) persisted across timepoints within the ACLR group compared to the controls (p < 0.05).

Conclusion: The results indicate ACLR individuals exhibit a distinct and rigid coordination pattern during gait compared to controls within 6-month post-ACLR, which may have long-term implications for knee-joint health.

Keywords: Coordination; Cross-recurrence quantification analysis; Gait; Nonlinear dynamics; Osteoarthritis.