The kinematic characteristics and their variabilities of patients walking at different speeds after anterior cruciate ligament reconstruction
Objective To analyze the gait kinematics characteristics and their variabilities of patients walking at comfortable speed and maximum speed 6 months after anterior cruciate ligament reconstruction(ACLR)surgery.Methods A total of 21 subjects 6 months after ACLR surgery and 21 healthy subjects were recruited.A three-dimensional motion capture system was used to collect the gait data of the subjects walking at a comfortable speed and maximum speed.We calculated the gait spatiotemporal parameters and the kinematic parameters of hip,knee and ankle joints,and the stride-to-stride variation coefficient of each parameter that can reflect the gait variability.The differences in parameters between ACLR subjects and healthy subjects were compared at the two gait speeds.Results When walking at a comfortable speed,the gait speed[ACLR vs.health(1.13±0.24)m/s vs.(1.26±0.12)m/s],cadence[(106.03±11.27)steps/min vs.(112.25±5.80)steps/min]and step length[(0.63±0.08)m vs.(0.67±0.04)m]of the operated side were smaller,and the step time[(1.15±0.13)m vs.(1.07±0.05)m]was extended.The knee joint range of motion(ROM)[(53.77±11.09)° vs.(61.27±5.67)°],ankle joint ROM[(29.00±4.92)° vs.(32.62±5.13)°],and the plantarflexion excursion during the late stance phase[(28.99±4.92)° vs.(32.59±5.17)°]were smaller.Among the variability parameters,only the hip extension excursion[(3.00±1.98)%vs.(4.58±1.92)%]was small.When walking at a maximum speed,the knee joint ROM[(53.93±11.58)° vs.(59.53±6.44)°]of the operated side was still smaller,and the plantarflexion excursion during early stance phase[(6.38±2.48)° vs.(4.83±1.97)°]was increased.Among the variability parameters,the gait speed[(4.77±2.88)%vs.(8.73±7.89)%],cadence[(3.20±1.31)%vs.(5.75±4.25)%],step length[(3.94±1.72)%vs.(5.72±3.21)%],step time[(3.19±1.29)%vs.(5.88±4.50)%],hip extension excursion,[(4.06±1.92)%vs.(6.49±3.27)%],ankle ROM[(5.84±3.15)%vs.(13.12±7.50)%],and the plantarflexion excursion during the late stance phase[(6.05±3.43)%vs.(14.54±11.00)%]were smaller.Conclusions ACLR subjects develop a more stable gait pattern when walking at a comfortable speed,but this pattern is more conservative than that of healthy subjects.When walking at maximum speed,the gait patterns of ACLR subjects are closer to those of healthy subjects,but they are more rigid and less flexible.This may be related to the incomplete recovery of proprioceptive and neuromuscular function 6 months after ACLR.Therefore,patients should adopt more active rehabilitation strategies focusing on proprioceptive and neuromuscular control training to improve the gait pattern and gait control ability.
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