Comparison of Limb Loading Characteristics and Subjective Functional Outcomes Between Sexes Following ACLR

Dr Amelia S Bruce Leicht; Mr Xavier D Thompson; Dr Robin M Queen; Dr Jordan Rodu; Dr Michael J Higgins; Dr Kevin M Cross; Dr Brian C Werner; Dr Jacob E Resch; Dr Joe M Hart

doi:10.4085/1062-6050-0534.23

Comparison of Limb Loading Characteristics and Subjective Functional Outcomes Between Sexes Following ACLR

J Athl Train. 2024 Apr 17. doi: 10.4085/1062-6050-0534.23. Online ahead of print.

Authors

Dr Amelia S Bruce Leicht¹, Mr Xavier D Thompson², Dr Robin M Queen³, Dr Jordan Rodu⁴, Dr Michael J Higgins², Dr Kevin M Cross⁵, Dr Brian C Werner⁶, Dr Jacob E Resch², Dr Joe M Hart⁷

Affiliations

¹ University of Kentucky, Department of Athletic Training and Clinical Nutrition, Lexington, KY.
² University of Virginia, Department of Kinesiology, Charlottesville, VA.
³ Virginia Tech, Department of Biomedical Engineering and Mechanics, Blacksburg, VA.
⁴ University of Virginia, Department of Statistics, Charlottesville, VA.
⁵ University of Virginia, Department of Physical Medicine and Rehabilitation, Charlottesville, VA.
⁶ University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA.
⁷ University of North Carolina, Department of Orthopaedics, Chapel Hill, NC.

PMID: 38629487
DOI: 10.4085/1062-6050-0534.23

Abstract

Context: ACL reconstruction (ACLR) patients commonly adopt poor movement patterns that potentially place them at an increased risk for reinjury if untreated. Limb loading characteristics during functional tasks can highlight movement compensations.

Objective: Examine loading symmetry during a bilateral bodyweight squatting task between sexes, compare loading metrics between limbs and sexes, and describe the relationship between loading metrics and patient reported outcomes (PROs) following ACLR.

Design: Cross-Sectional Study.

Setting: Laboratory.

Patients or other participants: 142 patients (71M/71F, 24.4±11.10yrs) with a primary, unilateral, uncomplicated ACLR completed a squatting assessment and PROs at approximately 5.2 months post-ACLR.

Main outcome measure(s): Normalized limb loading peak force (N/kg) and unilateral cumulative load (%) were collected bilaterally during the squatting task. Limb symmetry index (%) was calculated for normalized peak force. Our first objective compared limb loading symmetry (%) between sexes using independent samples t-test. Our second objective assessed differences in limb loading metrics between limbs and sexes were analyzed via an analysis of covariance. Our third objective was assessed using Spearman Rho correlations to determine the relationship between limb loading metrics and PROs.

Results: The majority of individuals (91/142, 64.1%) offloaded their ACLR limb (ACLR: 6.6±1.56 N/kg; contralateral: 7.3±1.61 N/kg, p<0.001). Females significantly offloaded their ACLR limb (ACLR: 6.3±1.38 N/kg; contralateral: 7.2±1.62 N/kg, p<0.001) where males did not significantly offload their ACLR limb (ACLR 6.98±1.65 N/kg; contralateral: 7.4±1.60, p=0.07). Weak relationships were observed (ρ-value range: -0.23 to 0.19) across limb loading metrics and PROs.

Conclusion: Individuals approximately five months following ACLR, on average, offloaded their ACLR limb compared to the contralateral limb. Patients' tendency to offload their weight during a squat was influenced by sex. Relationships between limb loading metrics and PROs indicate patients who load their limbs disproportionately have a lower perception in their capability to complete activities of daily living and lower subjective knee function.

Keywords: Bilateral Squat; Offloading; Rehabilitation; Return-to-Activity.