Use of Wearable Technology to Detect and Alter Subtle Gait Asymmetries Following Anterior Cruciate Ligament Reconstruction

Links

URL: http://digital.library.wisc.edu/1793/92522

Abstract

Knee osteoarthritis is a significant problem post-anterior cruciate ligament (ACL) reconstruction. Knee osteoarthritis can develop due to subtle changes in knee mechanics that affect loading on knee joint cartilage. Gait deficits during the loading phase have been observed up to four years post-surgery. However, changes in peak shank angular velocity have not been established long-term post-surgery. Peak shank angular velocity could be increased via an inertial measurement unit (IMU) based-biofeedback protocol to ultimately improve knee mechanics. Therefore, the objective of this project was to understand gait characteristics one to four years post-ACL reconstruction and to examine the effect of an IMU-based biofeedback protocol.

Twenty healthy participants and seven participants one to four years post-ACL reconstruction walked over-ground at 1.4 m/s while an IMU measured angular velocity of the shank and a three-dimensional motion capture system measured traditional gait kinematics and kinetics. Comparisons were made between groups and between limbs within the ACL-reconstructed group. Correlations were assessed between peak shank angular velocity traditionally measured kinematics and kinetics. Six participants in the ACL-reconstructed group then participated in a biofeedback session on a treadmill intended to increase peak shank angular velocity. Gait mechanics were assessed pre- and post-biofeedback for over-ground walking.

Peak shank angular velocity was significantly decreased in both ACL-reconstructed limbs compared to the healthy group. Knee range of motion and peak internal knee extension moment, two primary risk factors for developing knee osteoarthritis in this population, did not differ from the healthy group. Hip and ankle kinematics and kinetics did differ between groups. Only knee flexion at initial contact was different between ACL-reconstructed limbs. Additionally, peak shank angular velocity was moderately correlated with knee and hip range of motion, and peak internal knee extension moment. Post-biofeedback, peak shank angular velocity increased in both limbs. Changes were primarily observed in hip mechanics and stance time, rather than at the knee. However, asymmetries were present post-biofeedback in peak shank angular velocity, knee flexion at initial contact, and peak knee flexion during the loading phase. This work demonstrates that an inexpensive and portable device can detect abnormal gait patterns long-term post-ACL reconstruction and has the potential to be used in a biofeedback protocol to alter gait parameters that may reduce the risk of knee osteoarthritis for individuals post-ACL reconstruction.

Cited Works (12)

Year	Entry
2006	Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rhuematol. September 2006;18(5):514-518.
1997	De Luca CJ. The use of surface electromyography in biomechanics. J Appl Biomech. May 1997;13(2):135-163.
1957	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. December 1957;16(4):494-502.
2005	Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. April 2005;33(4):492-501.
2007	Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury–reduction regimen. Arthroscopy. December 2007;23(12):1320-1325.
1980	Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg. March 1980;62A(2):259-270.
2007	Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. October 2007;35(10):1756-1769.
2004	Lohmander LS, Östenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. October 2004;50(10):3145-3152.
2005	Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer: a 13-year review. Am J Sports Med. April 2005;33(4):524-530.
2000	Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick R, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. ;8(3):141-150.
1995	Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. December 1995;3(3):261-267.
2005	Ford K, Myer G, Toms H, Hewett T. Gender differences in the kinematics of unanticipated cutting in young athletes. Med Sci Sports Exer. 2005;37(1):124-129.