To evaluate the effect of knee hyperextension on dynamic in vivo kinematics after anterior cruciate ligament reconstruction (ACL-R).
Forty-two patients underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking and downhill running on a treadmill while dynamic stereo radiographs were acquired at 100 (walking) and 150 Hz (running). Tibiofemoral motion was determined using a validated model-based tracking process, and tibiofemoral translations/rotations were calculated. The range of tibiofemoral motions from 0 to 10% of the gait cycle (heel strike to early stance phase) and side-to-side difference (SSD) were calculated. Maximum knee extension angle of ACL-reconstructed knees during walking was defined as active knee extension angle in each subject. Correlations between maximum knee extension angle and tibiofemoral kinematics data were evaluated using Spearman’s rho (P < 0.05).
No significant correlation was observed between maximum knee extension angle and the range of anterior tibial translation during functional activities in the ACL-R knees. Maximum knee extension angle was weakly correlated with internal tibial rotation range in ACL-R knee during running (ρ = 0.376, P = 0.014); however, maximum extension angle was not correlated with SSD of internal tibial rotation. SSD of internal tibial rotation was −0.4° ± 1.9° (walking), −1.6° ± 3.1° (running), indicating ACL-R restored rotatory knee range of motion during functional movements.
Knee hyperextension was not significantly correlated with greater SSD of anterior translation and internal rotation. The clinical relevance is that knee hyperextension does not adversely affect kinematic outcomes after ACL-R and that physiologic knee hyperextension can be restored after ACL-R when knee hyperextension is present.
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Anterior cruciate ligament
Dynamic stereo X-ray
Magnetic resonance imaging
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The authors gratefully acknowledge the support with collecting data by Eric Thorhauer M.S., Yuichi Hoshino, M.D., Ph.D., Yoshimasa Fujimaki, M.D., Ph.D., Daisuke Araki, M.D., Ph.D., and Yuichiro Nishizawa, M.D., Ph.D.
Conflict of interest
The authors declare that we have no potential conflict of interest.
This study was supported by NIH/NIAMS Grant #R01 AR056630.
The institutional review board (IRB) for human subject research in University of Pittsburgh approved all aspects of this study (ID: PRO09020493).
Informed consent was obtained for all patients before enrolment.
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Nagai, K., Gale, T., Herbst, E. et al. Knee hyperextension does not adversely affect dynamic in vivo kinematics after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 448–454 (2018). https://doi.org/10.1007/s00167-017-4653-0
- Anterior cruciate ligament reconstruction
- Dynamic stereo X-ray system