Bilateral waveform analysis of gait biomechanics presurgery to 12 months following ACL reconstruction compared to controls

The purpose of this study was to compare gait biomechanics between limbs and to matched uninjured controls (i.e., sex, age, and body mass index) preoperatively and at 2, 4, 6, and 12 months following primary unilateral anterior cruciate ligament reconstruction (ACLR). Functional mixed effects models were used to identify differences in gait biomechanics throughout the stance phase between the a) ACLR limb and uninvolved limb, b) ACLR limb and controls, and c) uninvolved limb and controls. Compared with the uninvolved limb, the ACLR limb demonstrated lesser knee extension moment (KEM; within 8–37% range of stance) during early stance as well as lesser knee flexion moment (KFM; 45–84%) and greater knee flexion angle (KFA; 43–90%) during mid‐ to late stance at all timepoints. Compared with controls, the ACLR limb demonstrated lesser vertical ground reaction force (vGRF; 5–26%), lesser KEM (7–47%), and lesser knee adduction moment (KAM; 12–35%) during early stance as well as greater vGRF (39–63%) and greater KFA (34–95%) during mid‐ to late stance at all timepoints. Compared with controls, the uninvolved limb demonstrated lesser KFA (1–56%) and lesser KEM (12–54%) during early to mid‐stance at all timepoints. While gait becomes more symmetrical over the first 12 months post‐ACLR, the ACLR and uninvolved limbs both demonstrate persistent aberrant gait biomechanics compared to controls. Biomechanical waveforms throughout stance can be generally described as less dynamic following ACL injury and ACLR compared with uninjured controls. Clinical Significance Individuals with ACLR demonstrate less dynamic gait biomechanics waveforms bilaterally from the preop timepoint up to 12 months post‐ACLR, which may contribute to knee joint tissue breakdown. Further, gait retraining interventions need to consider bilateral approaches to normalize gait following unilateral ACLR.