Background: A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability.
Objective: The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics.
Methods: MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined.
Results: A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R.
Conclusion: After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability.
Systematic review registration: Registered in PROSPERO 2017, CRD42017077130.
Young Athletes With Quadriceps Femoris Strength Asymmetry at Return to Sport After Anterior Cruciate Ligament Reconstruction Demonstrate Asymmetric Single-Leg Drop-Landing MechanicsMP Ithurburn et al. Am J Sports Med 43 (11), 2727-37. PMID 26359376.At the time of return to sport, athletes who had undergone ACL reconstruction, including those in both the high- and low-quadriceps groups, demonstrated asymmetry during …
Gait Patterns Differ Between ACL-reconstructed Athletes Who Pass Return-To-Sport Criteria and Those Who FailSL Di Stasi et al. Am J Sports Med 41 (6), 1310-8. PMID 23562809.Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their poorer perfo …
Anterior Cruciate Ligament Reconstruction in Adolescent Patients: Limb Asymmetry and Functional Knee BracingB Dai et al. Am J Sports Med 40 (12), 2756-63. PMID 23035150.Adolescent patients 6 months after ACL reconstruction demonstrated significant kinematic and kinetic asymmetries between the surgical and nonsurgical limbs. The limb asym …
Movement Patterns of the Knee During Gait Following ACL Reconstruction: A Systematic Review and Meta-AnalysisM Kaur et al. Sports Med 46 (12), 1869-1895. PMID 26936269. - ReviewJoint kinematics are restored, on average, 6 years following reconstruction, while knee external flexion moments remain lower than controls. Knee adduction moments are lo …
Surgical Versus Conservative Interventions for Treating Anterior Cruciate Ligament InjuriesAP Monk et al. Cochrane Database Syst Rev 4 (4), CD011166. PMID 27039329. - ReviewFor adults with acute ACL injuries, we found low-quality evidence that there was no difference between surgical management (ACL reconstruction followed by structured reha …