Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture

Abstract

Background: Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop-jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts.

Methods: Subjects with unilateral ACL ruptures treated more than two decades ago (17-28years) conservatively with physiotherapy (ACL_PT, n=26) or in combination with reconstructive surgery (ACL_R, n=28) and healthy-knee controls (n=25) performed 40-cm drop-jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACL_PT and ACL_R vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods.

Results: Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACL_R also showed less trunk flexion during Rebound. Between-leg differences were observed in ACL_R only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACL_R and ACL_PT. However, compared to controls, deviations spanned a greater proportion of the drop-jump movement at the hip in ACL_R and at the knee in ACL_PT.

Conclusions: Trunk and bilateral leg kinematics during double-leg drop-jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACL_PT and ACL_R compared to controls.

Keywords: ACL; Biomechanics; Functional data analysis; Interval testing procedure; Lower extremity; Rehabilitation.