Differences in gait biomechanics in the first year after anterior cruciate ligament reconstruction: A systematic review.

Abstract

Altered gait biomechanics following anterior cruciate ligament reconstruction (ACLR) contribute to the 3-6 times greater risk of osteoarthritis development in this population compared to those without a knee injury. To mitigate the onset of osteoarthritis, it is necessary to understand gait recovery during the first year post-ACLR when patients have access to rehabilitative care. The purpose of this review was to compare ACLR limb gait biomechanics to the uninjured limb and healthy controls during the first year of recovery. Online database searches of PubMed, CINAHL, Scopus, and SportDiscus were conducted from inception to January 2025. Eligibility criteria included longitudinal studies of individuals with ACL injury who underwent ACLR (≤35 years of age) with a baseline gait assessment between pre-ACLR and 6 months post-ACLR and a follow up assessment <12 months post-surgical; and cross-sectional studies that met the same criteria except for study design. Methodological quality was assessed with the Black and Downs scale. Demographic and surgical characteristics and biomechanical outcomes were extracted from each study. Nine studies were included in the review. The ACLR limb gait biomechanics incrementally improved in the first year of recovery. However, the ACLR limb displayed smaller sagittal plane knee angles and internal moments and was underloaded in the first 50 % stance compared to the uninjured limb and healthy controls throughout the first year post-ACLR. Differences in frontal plane loading were inconsistent. Aberrant gait biomechanics associated with osteoarthritis development are not resolved during the time when patients have access to care.