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Lower-Extremity Compensations Following Anterior Cruciate Ligament Reconstruction

GP Ernst, PT, PhD, SCS, ATC, is a Commander in the Medical Service Corps, US Navy, and Assistant Professor, US Army–Baylor University Graduate Program in Physical Therapy, Fort Sam Houston, TX. Address all correspondence to CDR Ernst at 182 Artillery Post Rd, Fort Sam Houston, TX 78234 (USA) (gernst1{at}juno.com)
E Saliba, PT, PhD, SCS, ATC, is Assistant Professor in the Department of Human Services, Curry School of Education, University of Virginia. He is also Head Athletic Trainer at the University of Virginia
DR Diduch, MD, is Assistant Professor of Orthopedic Surgery at the University of Virginia
SR Hurwitz, MD, is Associate Professor of Orthopedic Surgery at the University of Virginia
DW Ball, PhD, is Professor in Educational Studies, Curry School of Education, University of Virginia

Background and Purpose. Several studies have demonstrated that patients with knee injury scored within a normal range during one-legged hop tests yet showed quadriceps femoris muscle weakness with non–weight-bearing isokinetic testing. This study evaluated lower-extremity kinetics while subjects performed a single-leg vertical jump (VJ) and a lateral step-up (LSU) in an attempt to explain this phenomenon. Subjects and Methods. Using a motion analysis and force platform system, hip, knee, and ankle extension moments of 20 subjects with anterior cruciate ligament (ACL) reconstructions and 20 matched subjects were measured while they performed an LSU and a VJ. Results. An analysis of variance revealed that the knee extension moment of the ACL-reconstructed extremity was lower than that of the uninjured and matched extremities during the LSU, VJ take-off, and VJ landing. However, there was no difference in summated extension moment (hip + knee + ankle) among extremities during the LSU and VJ take-off. The summated extension moment of the ACL-reconstructed extremity during VJ landing was less than that of the uninvolved and matched extremities. Conclusions and Discussion. These results suggest that the hip or ankle extensors may compensate for the knee extension moment deficit. The decrease in summated extension moment in the ACL-reconstructed extremity during VJ landing represents inadequate attenuation of landing forces, which may expose the skeleton and joint structures to injury.

Key Words: Anterior cruciate ligament reconstruction • Compensations • Functional tests • Lower-extremity kinetics

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