Individuals With an Anterior Cruciate Ligament-Reconstructed Knee Display Atypical Whole Body Movement Strategies but Normal Knee Robustness During Side-Hop Landings: A Finite Helical Axis Analysis

Background: Atypical knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) are common. It is, however, unclear whether knee robustness (ability to tolerate perturbation and maintain joint configuration) and whole body movement strategies are compromised after ACLR.

Purpose: To investigate landing control after ACLR with regard to dynamic knee robustness and whole body movement strategies during sports-mimicking side hops, and to evaluate functional performance of hop tests and knee strength.

Study Design: Controlled laboratory study.

Methods: An 8-camera motion capture system and 2 synchronized force plates were used to calculate joint angles and moments during standardized rebound side-hop landings performed by 32 individuals with an ACL-reconstructed knee (ACLR group; median, 16.0 months after reconstruction with hamstring tendon graft [interquartile range, 35.2 months]) and 32 matched asymptomatic controls (CTRL). Dynamic knee robustness was quantified using a finite helical axis approach, providing discrete values quantifying divergence of knee joint movements from flexion-extension (higher relative frontal and/or transverse plane motion equaled lower robustness) during momentary helical rotation intervals of 10°. Multivariate analyses of movement strategies included trunk, hip, and knee angles at initial contact and during landing and hip and knee peak moments during landing, comparing ACLR and CTRL, as well as legs within groups.

Results: Knee robustness was lower for the first 10° motion interval after initial contact and then successively stabilized for both groups and legs. When landing with the injured leg, the ACLR group, as compared with the contralateral leg and/or CTRL, demonstrated significantly greater flexion of the trunk, hip, and knee; greater hip flexion moment; less knee flexion moment; and smaller angle but greater moment of knee internal rotation. The ACLR group also had lower but acceptable hop and strength performances (ratios to noninjured leg >90%) except for knee flexion strength (12% deficit).

Conclusion: Knee robustness was not affected by ACLR during side-hop landings, but alterations in movement strategies were seen for the trunk, hip, and knee, as well as long-term deficits in knee flexion strength.

Clinical Relevance: Knee robustness is lowest immediately after landing for both the ACLR group and the CTRL and should be targeted in training to reduce knee injury risk. Assessment of movement strategies during side-hop landings after ACLR should consider a whole body approach.