2015 ISAKOS Biennial Congress ePoster #1126
Altered Three-Dimensional Knee Kinematics During Locomotion Following Multiple-Ligament Reconstruction
Corey Scholes, PhD, Crows Nest, NSW AUSTRALIA
Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, Hunters Hill, NSW AUSTRALIA
Joe Lynch, Canberra AUSTRALIA
Milad Ebrahimi, BEng (Hons), Sydney, NSW AUSTRALIA
Richard Smith, PhD, Sydney, NSW AUSTRALIA
Myles R. J. Coolican, FRACS, Sydney, NSW AUSTRALIA
David A. Parker, MBBS, BMedSc, FRACS, Sydney, NSW AUSTRALIA
Sydney Orthopaedic Research Institute, Sydney, NSW, AUSTRALIA
FDA Status Not Applicable
Summary: Three-dimensional knee kinematics during locomotion remain abnormal in patients following multiple-ligament knee reconstruction
Abstract:
Introduction
Multi-ligament knee injuries (MLKI) are serious injuries, with patients presenting with varying patterns of ligamentous disruption and significant associated injuries. Restoration of knee mechanics is important for functional outcome, as well as reducing the risk of joint degeneration. To-date there is little information reporting the kinematic outcome of complex reconstruction, particularly during locomotion, to guide the surgeon in the surgical planning process. The purpose of this study was to determine the kinematic differences between patients who have undergone multiple-ligament reconstruction (MLKR), and age- gender matched healthy controls.
Methods
Three-dimensional optoelectronic motion capture was performed on 16 patients (43.2+13.5yrs; 26.1+3.8kg/m2) that had undergone multiple-ligament knee reconstruction (ave follow-up 4.7yrs) and a group of healthy controls matched individually to each patient for age, gender, height and weight. Participants were recorded as they performed two separate locomotion tasks; i) level walking at a self-selected speed across the laboratory, ii) stair descent followed by a 90deg pivot on the reconstructed limb. Spatiotemporal parameters as well as three-dimensional knee angles were extracted from the motion capture data recorded for each task. Statistical analysis was performed using group- aggregated data using t-tests and ANOVA where appropriate, as well as for each patient- control matched pair using a single-subject approach.
Results
MLKR patients walked significantly (p<0.05) slower and with shorter steps than healthy controls during level walking. No significant differences in knee kinematics between patient and control groups could be observed due individual differences cancelling each other out. In contrast single-subject analysis revealed that a large proportion of the MLKR group differed significantly to their matched control for all variables. Up to 40% of patients displayed knee motion in the frontal and rotation planes that was in the opposite direction to that of healthy controls during the propulsion phase of level walking. MLKR patients also displayed significantly increased external rotation at foot-strike, as well as internal rotation during weight acceptance compared to controls during the stair-descent and pivot task. Single-subject analysis revealed that a majority of patients displayed significantly different knee kinematics in all 3 planes of motion during weight acceptance compared to their matched controls. MLKR patients pre-positioned their whole lower limb into external rotation in preparation for impact with the ground.
Conclusions
This study represents the most detailed analysis of locomotion function and knee kinematics in MLKR patients yet reported. The results indicate that functional deficits remain following MLKR during key load-bearing phases of the gait cycle and during stair descent. The differences in knee kinematics may have implications for the pathogenesis of post-traumatic osteoarthritis. Further investigation with a larger sample is required to quantify this link and determine the prognostic effectiveness of kinematic analysis in this population.