Running Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction: A Systematic Review
A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability.
The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics.
MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined.
A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R.
After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability.
Systematic review registration
Registered in PROSPERO 2017, CRD42017077130.
All authors contributed significantly to the review. BPdF was responsible for the conception of the review question and the extraction, analysis and interpretation of the data. ARCE and M-OD assisted with the risk of bias assessment and data extraction. J-SR assisted in the review design and revision of the manuscript. RWW and RLM provided advice throughout the review and contributed to the revision of the manuscript.
Compliance with Ethical Standards
No sources of funding were used to assist in the preparation of this article.
Conflict of Interest
Benoit Pairot-de-Fontenay, Richard W. Willy, Audrey R.C. Elias, Ryan L. Mizner, Marc-Olivier Dubé and Jean-Sébastien Roy have no conflicts of interest that are directly relevant to the content of this review.
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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