Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking

Background: It is possible that gait abnormalities may play a role in the pathogenesis of meniscal or chondral injury as well as osteoarthritis of the knee in patients with anterior cruciate ligament deficiency. Hypothesis: The three-dimensional kinematics of anterior cruciate ligament-deficient knees are changed even during low-stress activities, such as walking, but can be restored by reconstruction. Study Design: Case control study. Methods: Using a three-dimensional optoelectronic gait analysis system, we examined 13 patients with anterior cruciate ligament-deficient knees, 21 patients with anterior cruciate ligament-reconstructed knees, and 10 control subjects with uninjured knees during walking. Results: Normal patterns of knee flexion-extension, abduction-adduction, and internal-external rotation during the gait cycle were maintained by all subjects. A significant difference in tibial rotation angle during the initial swing phase was found in anterior cruciate ligament-deficient knees compared with reconstructed and control knees. The patients with anterior cruciate ligament-deficient knees rotated the tibia internally during the initial swing phase, whereas the others rotated externally. Conclusions: Patients with anterior cruciate ligament-deficient knees experienced repeated episodes of rotational instability during walking, whereas patients with reconstruction experienced tibial rotation that is closer to normal. Clinical Relevance: Repeated episodes of knee rotational instability may play a role in the development of pathologic knee conditions.