The Effect of Insufficient Quadriceps Strength on Gait After Anterior Cruciate Ligament Reconstruction

Objective: To determine the effect of quadriceps strength and joint stability on gait patterns after anterior cruciate ligament injury and reconstruction.

Design: Cross-sectional comparative study in which four groups underwent motion analysis with surface electromyography.

Background: Individuals following anterior cruciate ligament rupture often demonstrate reduced knee angles and moments during the early stance phase of gait. Alterations in gait can neither be ascribed to instability nor to quadriceps weakness alone when both are present.

Methods: Twenty-eight individuals with complete anterior cruciate ligament rupture (10 patients with acute rupture, 8 patients following reconstruction with quadriceps strength >90% of the uninvolved side [strong-anterior cruciate ligament reconstructed group], and 10 patients after reconstruction with quadriceps strength <80% of the uninvolved side [weak-anterior cruciate ligament reconstructed group]), and 10 uninjured subjects underwent an examination of their lower extremity to collect kinematics, kinetics, and electromyography during walking and jogging. Anterior cruciate ligament reconstruction was arthroscopically assisted and a double loop semitendinosis-gracilis autograft or allograft was used as a graft source. All reconstructed subjects had stable knees, full range of motion, and no effusion or pain at the time of testing (more than three months after surgery).

Results: Knee angles and moments of the strong group were indistinguishable from the uninjured group during early stance of both walking and jogging. The weak subjects had reduced knee angles and moments during walking, and jogged similarly to the deficient subjects. Regression analysis revealed a significant effect between early stance phase knee angles and moments and quadriceps strength during both walking and jogging.

Conclusion: Inadequate quadriceps strength contributes to altered gait patterns following anterior cruciate ligament reconstruction.

Relevance: Rapid strengthening following anterior cruciate ligament injury or reconstruction may contribute to a safe return to high-level activities.