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Gait Analysis in Anterior Cruciate Ligament Reconstruction & Controls Across Different Levels of Visual Feedback

Journal: Unpublished MSc thesis Ohio University, Date: 2021/09, Pages: 83, type of study: observational study

Free full text   (https://etd.ohiolink.edu/apexprod/rws_olink/r/1501/10?clear=10&p10_accession_num=ohiou1617872112807014)

Keywords:

anterior cruciate ligament [5]
biomechanics [55]
gait [25]
injuries [66]
kinetics [1]
knee [70]
limb symmetry [1]
observational study [126]
osteoarthritis [28]
post-operative care [28]

Abstract:

Alterations in lower extremity kinematic and kinetics during functional tasks such as gait, running, landing and change of direction maneuvers are frequently seen long after anterior cruciate ligament reconstruction (ACLR) and have been hypothesized to contribute to the development of secondary anterior cruciate ligament (ACL) injury and post traumatic osteoarthritis (PTOA). The ACL typically provides afferent sensory information via mechanoreceptors, however, following an ACL injury these mechanoreceptors are disrupted. The central nervous system (CNS) as a result undergoes compensatory modifications prioritizing visual feedback in order to effectively organize neuromuscular control. When vision is obstructed, alterations in motor control during functional activities such as gait may increase secondary ACL injury risk and PTOA. Stroboscopic glasses reduce visual reliance for neuromuscular regulation of the injured limb by providing intermittent snapshots of an individual’s environment without completely obstructing it. Our goal was to assess the relationship between the biomechanical alterations that take place following an ACLR with variable levels of visual perturbation via stroboscopic glasses. We hypothesized knee flexion excursion, knee extensor moment, and knee abduction moment would be lower in the ACLR limb 4 compared to the healthy controls with further reductions in these variables with increasing levels of visual perturbation during gait. Twenty-four individuals completed a data collection session during which five separate walking gait trials were analyzed. The ACLR group (8 women, 4 men; age = 22.00 ± 2.45 years; height = 1.70 ± 0.10 m; weight = 67.67 ± 16.00 kg; Tegner Activity Scale score = 7.42 ± 1.08; time since surgery = 35.40 ± 24.67 months; hamstring grafts = 10, patellar tendon = 2) had been cleared for full return to physical activity by their physicians and were engaged in regular physical activity. The healthy control group (8 women, 4 men; age = 21.92 ± 2.47 years; height = 1.73 ± 0.10 m; weight = 69.61 ± 14.77 kg; Tegner Activity Scale score = 7.50 ± 1.17) had no history of lower extremity injury. Kinetic and kinematic outcomes measures were recorded during each trial. Biomechanical outcomes were presented using a limb symmetry index (left limb value/right limb value) x 100%. The primary variables of interest were knee flexion excursion (KFE), knee extensor moment (KEM), and knee abduction moment (KAM). Primary variables of interest were reported as limb symmetry index (LSI) percentages. A repeated measures ANOVA was conducted for each dependent variable (3) with the between subjects group (ACL vs. Controls) and the within subjects factor condition visual perturbation level). Post-hoc testing was conducted as appropriate. Alpha level was set at 0.05 for all analyses. KFE LSI was found to be significantly different between ACLR (92.82± 15.15) and healthy control (102.45± 10.08) groups regardless of visual perturbation. There was 5 no significant difference found between KEM LSI and KAM LSI when evaluating these two groups. The visual perturbation conditions elicited no statistically differences in the biomechanical variables of interest for our study across ACLR and healthy control groups. Stroboscopic visual perturbation did not alter the gait mechanics we evaluated in this study. However, a significant group effect was noted between ACLR and healthy controls. A reduction in KFE LSI indicates the involved limb went through less range of motion during the first 50% of stance phase which supports prior ACLR gait analysis studies. The neuromuscular effects of stroboscopic visual training may require a more demanding task to challenge cross-modal visual-spatial integration neural networks.


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