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Immediate effects of walking with a knee brace following anterior cruciate ligament reconstruction
A biomechanical, biochemical, and structural approach
Evans-Pickett, A., Davis-Wilson, H. C., Johnston, C. D., Blackburn, J. T., Hackney, A. C., & Pietrosimone, B. (2023). Immediate effects of walking with a knee brace following anterior cruciate ligament reconstruction: A biomechanical, biochemical, and structural approach. Journal of Athletic Training, 58(6), 542-553. https://doi.org/10.4085/1062-6050-0700.20
CONTEXT: Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis (PTOA). Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to PTOA onset. Knee braces have been used to modify joint tissue loading in individuals with joint injury; yet, the effects of walking with a brace following ACLR on biomechanical, biological, and structural cartilage outcomes are unknown.
OBJECTIVE: To compare biomechanical, biochemical, and structural outcomes between braced and non-braced walking in ACLR individuals.
DESIGN: Cross-over study.
SETTING: Research laboratory.
PARTICIPANTS: 34 individuals with unilateral ACLR (time since ACLR = 50±37 months; 18 females, 16 males).
INTERVENTIONS: Gait bioemchanics were assessed during braced (Rebound Cartilage; Ossur, Reykavik, Iceland) and unbraced conditions on separate days.
MAIN OUTCOME MEASURES: Vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) waveforms were evaluated throughout the stance phase and compared between conditions. Percent changes of serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross sectional area (%ΔCSA) measured via ultrasound were calculated following a 3000-step walking protocol.
RESULTS: Braced walking increased KFA (largest difference: 3.56°; effect size: d=1.72) and increased KEM (largest difference: 0.48 %Body Weight×Height; effect size: d=1.14) compared to non-braced walking but did not influence vGRF. While there was no significant difference (p=0.196) in %ΔCOMP between the braced and non-braced conditions in the entire cohort(n=30), there was a larger increase (p=0.036) in %ΔCOMP during non-braced compared to braced walking in individuals who demonstrated increased COMP during non-braced walking. There was no difference (p=0.86) in %ΔCSA between the braced and non-braced conditions.
CONCLUSIONS: Braced walking may improve sagittal plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (i.e., increase in COMP) following non-braced walking.
