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Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):448-454. doi: 10.1007/s00167-017-4653-0. Epub 2017 Jul 15.

Knee hyperextension does not adversely affect dynamic in vivo kinematics after anterior cruciate ligament reconstruction.

Author information

1
Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
2
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
3
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
4
Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA. ffu@upmc.edu.

Abstract

PURPOSE:

To evaluate the effect of knee hyperextension on dynamic in vivo kinematics after anterior cruciate ligament reconstruction (ACL-R).

METHODS:

Forty-two patients underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking and downhill running on a treadmill while dynamic stereo radiographs were acquired at 100 (walking) and 150 Hz (running). Tibiofemoral motion was determined using a validated model-based tracking process, and tibiofemoral translations/rotations were calculated. The range of tibiofemoral motions from 0 to 10% of the gait cycle (heel strike to early stance phase) and side-to-side difference (SSD) were calculated. Maximum knee extension angle of ACL-reconstructed knees during walking was defined as active knee extension angle in each subject. Correlations between maximum knee extension angle and tibiofemoral kinematics data were evaluated using Spearman's rho (P < 0.05).

RESULTS:

No significant correlation was observed between maximum knee extension angle and the range of anterior tibial translation during functional activities in the ACL-R knees. Maximum knee extension angle was weakly correlated with internal tibial rotation range in ACL-R knee during running (ρ = 0.376, P = 0.014); however, maximum extension angle was not correlated with SSD of internal tibial rotation. SSD of internal tibial rotation was -0.4° ± 1.9° (walking), -1.6° ± 3.1° (running), indicating ACL-R restored rotatory knee range of motion during functional movements.

CONCLUSION:

Knee hyperextension was not significantly correlated with greater SSD of anterior translation and internal rotation. The clinical relevance is that knee hyperextension does not adversely affect kinematic outcomes after ACL-R and that physiologic knee hyperextension can be restored after ACL-R when knee hyperextension is present.

LEVEL OF EVIDENCE:

III.

KEYWORDS:

ACL; Anterior cruciate ligament reconstruction; Dynamic stereo X-ray system; Hyperextension; Kinematics; Knee

PMID:
28712024
DOI:
10.1007/s00167-017-4653-0
[Indexed for MEDLINE]

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