Skip to main content
Log in

Adaptations of gait and muscle activation in chronic ACL deficiency

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The purpose was to investigate whether deviations in gait parameters or muscular activity patterns can be detected in the injured and healthy leg of chronic ACL-deficient subjects. Sixteen medium-level active chronic ACL-deficient patients classified as “copers” (injury duration: 12–240 months, age 17–52 years) and 15 healthy subjects (age 20–33 years) walked at self-selected speed along a 10-m runway with a level force-plate. Gait specific data, ground reaction forces, knee and ankle angles, and EMG were documented. Knee laxity was increased and the functional scores (Lysholm, KOOS) decreased in the ACL- deficient subjects, whereas the Tegner activity level score was normal. Gait speed, stride length and stance time did not differ between ACL-deficient subjects and controls. Ground reaction forces (magnitude and times), as well as knee and ankle angles at selected points during stance and swing phases were normal in the ACL-deficient subjects compared to controls. The total duration of m. tibialis anterior (TA) activity was longer in ACL-deficient subjects than in controls (ACL-deficient injured leg vs. controls, P < 0.05). In addition, the onset of lateral gastrocnemius (LG) muscle activity occurred earlier in ACL-deficient patients (P < 0.03), resulting in a TA-LG cocontraction in the ACL-deficient but not in the control group. In conclusion, chronic, medium-level active ACL-deficient patients showed abnormalities in muscular activity patterns during gait compared to control subjects, whereas there were no detectable changes in ground reaction forces and 3D kinematic data. As the aberrant muscular activity pattern may be of importance for an even gait, it is proposed that EMG recordings may give additional information in the evaluation and rehabilitation of gait when the ACL is absent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ageberg E, Friden T (2008) Normalized motor function but impaired sensory function after unilateral non-reconstructed ACL injury: patients compared with uninjured controls. Knee Surg Sports Traumatol Arthrosc 16:449–456

    Article  PubMed  Google Scholar 

  2. Andriacchi TP, Briant PL, Bevill SL et al (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44

    Article  PubMed  Google Scholar 

  3. Andriacchi TP, Dyrby CO (2005) Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech 38:293–298

    Article  PubMed  Google Scholar 

  4. Andriacchi TP, Mundermann A, Smith RL et al (2004) A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng 32:447–457

    Article  PubMed  Google Scholar 

  5. Berchuck M, Andriacchi TP, Bach BR et al (1990) Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg Am 72:871–877

    CAS  PubMed  Google Scholar 

  6. Binder-Macleod BI, Buchanan TS (2006) Tibialis anterior volumes and areas in ACL-injured limbs compared with unimpaired. Med Sci Sports Exerc 38:1553–1557

    Article  PubMed  Google Scholar 

  7. Bulgheroni P, Bulgheroni MV, Andrini L et al (1997) Gait patterns after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 5:14–21

    Article  CAS  PubMed  Google Scholar 

  8. Chmielewski TL, Rudolph KS, Fitzgerald GK et al (2001) Biomechanical evidence supporting a differential response to acute ACL injury. Clin Biomech (Bristol, Avon) 16:586–591

    Article  CAS  Google Scholar 

  9. Ciccotti MG, Kerlan RK, Perry J et al (1994) An electromyographic analysis of the knee during functional activities. II. The anterior cruciate ligament-deficient and -reconstructed profiles. Am J Sports Med 22:651–658

    Article  CAS  PubMed  Google Scholar 

  10. Ferber R, Osternig LR, Woollacott MH et al (2002) Gait mechanics in chronic ACL deficiency and subsequent repair. Clin Biomech (Bristol, Avon) 17:274–285

    Article  Google Scholar 

  11. Goldberg SR, Anderson FC, Pandy MG et al (2004) Muscles that influence knee flexion velocity in double support: implications for stiff-knee gait. J Biomech 37:1189–1196

    Article  PubMed  Google Scholar 

  12. Hirschfeld H (1997) Do infants have motor responses to sudden surface rotations in prone position? J Vestib Res 7:265–276

    Article  CAS  PubMed  Google Scholar 

  13. Hortobagyi T, Westerkamp L, Beam S et al (2005) Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 20:97–104

    Article  Google Scholar 

  14. Houck J, Yack HJ (2003) Associations of knee angles, moments and function among subjects that are healthy and anterior cruciate ligament deficient (ACLD) during straight ahead and crossover cutting activities. Gait Posture 18:126–138

    Article  PubMed  Google Scholar 

  15. Hubley-Kozey CL, Deluzio KJ, Landry SC et al (2006) Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. J Electromyogr Kinesiol 16:365–378

    Article  CAS  PubMed  Google Scholar 

  16. Hurd WJ, Snyder-Mackler L (2007) Knee instability after acute ACL rupture affects movement patterns during the mid-stance phase of gait. J Orthop Res 25:1369–1377

    Article  PubMed  Google Scholar 

  17. Kerrigan DC, Todd MK, Della Croce U (1998) Gender differences in joint biomechanics during walking: normative study in young adults. Am J Phys Med Rehabil 77:2–7

    Article  CAS  PubMed  Google Scholar 

  18. Knoll Z, Kocsis L, Kiss RM (2004) Gait patterns before and after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:7–14

    Article  PubMed  Google Scholar 

  19. Lass P, Kaalund S, leFevre S et al (1991) Muscle coordination following rupture of the anterior cruciate ligament. Electromyographic studies of 14 patients. Acta Orthop Scand 62:9–14

    Article  CAS  PubMed  Google Scholar 

  20. Lewek M, Rudolph K, Axe M et al (2002) The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 17:56–63

    Article  Google Scholar 

  21. Lohmander LS, Englund PM, Dahl LL et al (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769

    Article  PubMed  Google Scholar 

  22. Moraiti C, Stergiou N, Ristanis S et al (2007) ACL deficiency affects stride-to-stride variability as measured using nonlinear methodology. Knee Surg Sports Traumatol Arthrosc 15:1406–1413

    Article  PubMed  Google Scholar 

  23. Muellner T, Bugge W, Johansen S et al (2001) Inter- and intratester comparison of the Rolimeter knee tester: effect of tester’s experience and the examination technique. Knee Surg Sports Traumatol Arthrosc 9:302–306

    Article  CAS  PubMed  Google Scholar 

  24. Paradowski PT, Bergman S, Sunden-Lundius A et al (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38

    Article  PubMed  Google Scholar 

  25. Roberts CS, Rash GS, Honaker JT et al (1999) A deficient anterior cruciate ligament does not lead to quadriceps avoidance gait. Gait Posture 10:189–199

    Article  CAS  PubMed  Google Scholar 

  26. Roos EM (2005) Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol 17:195–200

    Article  PubMed  Google Scholar 

  27. Roos EM, Roos HP, Lohmander LS et al (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    CAS  PubMed  Google Scholar 

  28. Rudolph KS, Axe MJ, Buchanan TS et al (2001) Dynamic stability in the anterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc 9:62–71

    Article  CAS  PubMed  Google Scholar 

  29. Rudolph KS, Eastlack ME, Axe MJ et al (1998) 1998 Basmajian Student Award Paper: Movement patterns after anterior cruciate ligament injury: a comparison of patients who compensate well for the injury and those who require operative stabilization. J Electromyogr Kinesiol 8:349–362

    Article  CAS  PubMed  Google Scholar 

  30. Shelburne KB, Torry MR, Pandy MG (2006) Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res 24:1983–1990

    Article  PubMed  Google Scholar 

  31. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 4:3–49

    Google Scholar 

  32. Torry MR, Decker MJ, Ellis HB et al (2004) Mechanisms of compensating for anterior cruciate ligament deficiency during gait. Med Sci Sports Exerc 36:1403–1412

    Article  PubMed  Google Scholar 

  33. Wexler G, Hurwitz DE, Bush-Joseph CA et al (1998) Functional gait adaptations in patients with anterior cruciate ligament deficiency over time. Clin Orthop Relat Res 16:6–175

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank Ingmarie Apel for the assistance in collecting the 3D kinematic data.

Competing interests

The authors declare that they have no competing interests. The study was fully supported by research grants from Karolinska Institutet and The Center for Caring Sciences (Centrum för Vårdvetenskap) in Stockholm, Sweden.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria Lindström.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lindström, M., Felländer-Tsai, L., Wredmark, T. et al. Adaptations of gait and muscle activation in chronic ACL deficiency. Knee Surg Sports Traumatol Arthrosc 18, 106–114 (2010). https://doi.org/10.1007/s00167-009-0886-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0886-x

Keywords

Navigation