Article

A variety of biomechanical adaptations of the knee during gait have
been reported in ACL-deficient patients to cope with anteroposterior knee
instability. However, strategies to prevent rotatory knee instability are less
recognized. We hypothesized that ACL-deficient patients would make distinctive
gait changes to prevent anterolateral rotatory knee instability. Specifically, we
hypothesized that during the terminal stance phase of the gait cycle,
ACL-deficient patients would reduce the internal rotation knee joint moment and
exhibit a higher knee flexion angle. We call this altered gait a pivot-shift
avoidance gait. We also hypothesized that patients would not be able to adapt
their knee biomechanics as efficiently at a fast gait speed. METHODS: Twenty-nine
patients with chronic ACL deficiency and 15 healthy volunteers took part in a
treadmill gait analysis. The terminal stance phase was analyzed under both
comfortable and fast gait speed conditions. FINDINGS: At both gait speeds,
ACL-deficient patients significantly reduced the internal rotation knee joint
moment and showed larger knee flexion angles during the terminal stance phase of
the gait cycle than did the control group. However, the difference in the minimum
knee flexion angle between groups under the fast gait speed condition was not
statistically significant. INTERPRETATION: ACL-deficient patients adopted the
proposed pivot-shift avoidance gait, possibly to prevent anterolateral rotatory
knee instability. The patients were not able to adapt their knee biomechanics as
effectively during fast-paced walking. This study reinforces the pertinence of
gait analysis in ACL-deficient knees to acquire more information about the
function of the knee joint.
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Langue : ANGLAIS