Knee muscle activity during gait in patients with anterior cruciate ligament injury: a systematic review of electromyographic studies

Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1432-1442. doi: 10.1007/s00167-015-3925-9. Epub 2015 Dec 24.


Purpose: This review compared knee muscle activity between ACL-deficient (ACLD) patients and healthy controls during gait, to find out whether the available electromyography (EMG) studies support Quadriceps (Q-ceps) inhibition or hamstring facilitation during gait in ACLD patients.

Method: A systematic review was conducted to retrieve the EMG studies of knee muscles during gait in ACLD patients. Cochrane library, PubMed, Medline, Ovid, CINAHL and Science Direct databases were searched entries from 1995 through October 2014 using the terms "anterior cruciate ligament" OR "ACL", "electromyography" Or "EMG" "gait" Or "walking". Articles that assessed subjects with ACL rupture that used surface EMG to assess the knee muscle activity were included. The quality of the included papers was assessed using the Critical Appraisal Skills Programme tool for observational studies.

Result: In total, 13 studies met the inclusion criteria. Seven studies consistently found no significant difference in magnitude of activity or timing of Q-ceps muscle between the chronic ACLD patients and control subjects. Two studies on acute ACLD patients and three studies on ACLD patients with unstable knee found the significantly reduced Q-ceps activity compared to control subjects. Six studies showed the significantly greater hamstring activity, and three studies found prolonged duration of activity in ACLD patients compared to the control subjects.

Conclusion: This review highlighted that the results of the studies are in favour of increased hamstring muscular activity. However, decreased Q-ceps activation exists in the acute stage and in ACLD patients that experience knee instability (non-copers).

Level of evidence: III.

Keywords: Anterior cruciate ligament injury; Electromyography; Gait.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / physiopathology
  • Anterior Cruciate Ligament Injuries / physiopathology*
  • Electromyography*
  • Female
  • Gait / physiology*
  • Hamstring Muscles / physiopathology*
  • Humans
  • Joint Instability / physiopathology
  • Knee / physiopathology*
  • Knee Joint / physiopathology
  • Male
  • Quadriceps Muscle / physiopathology*
  • Walking / physiology