Effects of Limb Dominance on Patellofemoral Joint Loading During Gait at 12 Weeks After Anterior Cruciate Ligament Reconstruction

Shiho Goto; J Craig Garrison; Steven B Singleton; Lindsey N Dietrich; Joseph P Hannon

doi:10.1177/23259671221088316

Effects of Limb Dominance on Patellofemoral Joint Loading During Gait at 12 Weeks After Anterior Cruciate Ligament Reconstruction

Orthop J Sports Med. 2022 Jul 29;10(7):23259671221088316. doi: 10.1177/23259671221088316. eCollection 2022 Jul.

Authors

Shiho Goto¹, J Craig Garrison^{2

3}, Steven B Singleton⁴, Lindsey N Dietrich⁵, Joseph P Hannon⁶

Affiliations

¹ Texas Health Sports Medicine, Fort Worth, Texas, USA.
² Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
³ Athletic Movement Performance Laboratory, Northwestern University, Chicago, Illinois, USA.
⁴ University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁵ Sideline Orthopedics and Sports, Arlington, Texas, USA.
⁶ Young Athlete Center, St Louis Children's Hospital, St Louis, Missouri, USA.

Abstract

Background: Patellofemoral joint complications have commonly been reported in long-term outcome studies for anterior cruciate ligament reconstruction (ACLR); however, the biomechanics in the early phases of rehabilitation that could be associated with the development of these abnormalities is unclear. Limb dominance may affect the biomechanics of the knee joint in patients after ACLR.

Purpose: To compare knee joint loading between surgical and nonsurgical limbs at 12 weeks postoperatively in patients who underwent ACLR on either their dominant limb (ACL-D) or nondominant limb (ACL-ND).

Study design: Controlled laboratory study.

Methods: Included were 54 patients (32 ACL-D and 22 ACL-ND). Peak and integrated patellofemoral joint stress (PFJS), peak patellofemoral joint reaction force (PFJRF), and peak knee extension moment (KEM) were assessed during the stance phase of gait while participants walked on a 10-m runway at a self-selected speed.

Results: The surgical limb of the ACL-D group had significantly decreased peak PFJS (P < .001), integrated PFJS (P < .001), peak PFJRF (P < .001), and peak KEM (P < .001) compared to the nonsurgical limb. The surgical limb of the ACL-ND group demonstrated significantly increased peak PFJS (P = .001), integrated PFJS (P = .023), peak PFJRF (P < .001), and peak KEM (P = .001) compared to the nonsurgical limb. For the surgical limb, the ACL-ND group demonstrated significantly greater peak PFJS (P < .001), peak PFJRF (P < .001) , (PFJRF [P<.001]) and peak KEM (P < .001) than the ACL-D group. For the nonsurgical limb, the ACL-D group demonstrated greater peak PFJS (P < .001), integrated PFJS (P = .023), peak PFJRF (P = .003), and peak KEM (P < .001) than the ACL-ND group.

Conclusion: Significantly larger knee joint loading on the surgical limb of the ACL-ND group and smaller knee joint loading on the surgical limb of the ACL-D group were observed compared to the contralateral nonsurgical limb, which suggests that limb dominance has a key role in loading at the knee joint during gait.

Clinical relevance: Altered knee joint loading during gait at 12 weeks after ACLR may lead to the development of patellofemoral joint abnormalities.

Keywords: anterior cruciate ligament reconstruction; limb dominance; loading; patellofemoral joint osteoarthritis; patellofemoral pain; stress.