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Females Demonstrate Increased Knee Adduction Moments 5 years after ACLR


Kathleen White, DPT
UNITED STATES

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Females Demonstrate Increased Knee Adduction Moments 5 years after ACLR

Kathleen White, DPT, UNITED STATES Lynn Snyder-Mackler, PT, ScD, FAPTA, UNITED STATES

University of Delaware, Newark, DE, USA

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Patient Populations

Sport Specific Population

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Osteoarthritis

Sports Medicine

Sport Specific Injuries Biomechanics

Ligaments

ACL

Summary: Females demonstrate greater knee adduction moments bilaterally when compared to males 5 years after ACL reconstruction, suggesting a sex-dependent progression of knee OA in these patients.

Introduction

Long term health of the knee joint is a growing concern as the incidence of OA rises after anterior cruciate ligament (ACL) injury [1]. More than half of female athletes demonstrate radiographic knee OA 10 years after ACL injury [2]. The knee adduction moment has been used to describe the potential mechanism of the progression of knee OA [3, 4]. Increased knee adduction moments are present in females 1-2 years after ACL reconstruction (ACLR) [5, 6]. The purpose of this study is to evaluate the external knee adduction moment during gait for males and females in our preliminary 5 year follow-up after ACLR.

Methods

Twenty-six subjects were included in this study (6 females, 20 males) that had an unilateral ACLR an average of 4.8(±0.8) years prior. All subjects participated in jumping, cutting and pivoting activities > 50 hrs/year at the time of their injury. Frontal plane biomechanical variables were collected for the external knee adduction moment at peak knee flexion during gait. Repeated measures ANOVA was used to determine differences between limbs and sex.

Significance

level of 0.05 was set a priori.

Results

There was an effect of sex (p=0.003) for the knee adduction moment at peak knee flexion. There was no limb x sex interaction (p=0.58), but a trend towards a main effect of limb (p=0.071) for the knee adduction moment. Females demonstrated greater external knee adduction moments bilaterally (Involved= 0.28 Nm/kg*m; (95% CI: 0.22, 0.34); Uninvolved= 0.32 Nm/kg*m; (95% CI: 0.26, 0.38)) compared to males (Involved= 0.196 Nm/kg*m; (95% CI: 0.16, 0.23); Uninvolved= 0.22 Nm/kg*m; (95% CI: 0.19, 0.25)).

Discussion

These preliminary data suggest that increased frontal plane moments are present in females 5 years after surgery. Increased knee adduction moments may be the mechanism associated with the progression of knee OA. The limited statistical significance is likely due to unequal groups and a limited number of female subjects.

Conclusion

These data are consistent with published works of athletes after surgery, however our 5 year follow up is a novel approach. Continued collection of these data will allow us to better describe the knee joint health of these athletes long term. Further examination of clinical measures as well as radiographs may better explain these variances.

References:
[1] Lawrence RC, et al., Arthritis Rheum 58, 2007. [2] Lohmander LS, et al., Arthritis Rheum 50, 2004. [3] Hurwitz DE, et al., J Orthop Res 20, 2002. [4] Andriacchi TP and Mundermann A, Curr Opin Rheumatol 18, 2006. [5] Webster KE, et al., B J Sports Med 40, 2011. [6] Butler RJ, et al., Br J Sports Med 43, 2009.