Knee muscle strength and movement biomechanics in individuals with and without knee pain after anterior cruciate ligament reconstruction: A cross-sectional study

PURPOSE: Anterior cruciate ligament injury increases the risk of knee osteoarthritis, possibly via early onset of knee pain and changes in musculoskeletal function. This study compared knee muscle strength and movement biomechanics during walking and forward lunge between individuals with and without knee pain after anterior cruciate ligament reconstruction.

METHODS: Cross-sectional study including participants at least 3 years post anterior cruciate ligament reconstruction, aged 18-40 at the time of surgery, and body mass index ≤30. Symptomatic participants were defined by a knee pain score (reconstructed knee) of ≥3 on a 0-10 scale during activities of daily living in the past week. Asymptomatic participants were defined by a pain score of 0. Maximal isometric quadriceps and hamstring muscle strength (Nm/kg) and 3D walking, and forward lunge movement biomechanics were measured.

RESULTS: A total of 122 participants (30% females) were included: 33 symptomatic and 89 asymptomatic (average age: 33.7, range 23.7-51.3 years). The average post-surgery time was 6 (range 3-10) years. The symptomatic group exhibited lower isometric quadriceps and hamstring strength with mean group differences (95% confidence interval [CI]) of 0.33 (0.10 to 0.56) Nm/kg and 0.19 (0.07 to 0.31) Nm/kg, respectively. There were no important group differences in the walking and forward lunge movement biomechanics.

CONCLUSIONS: Symptomatic individuals with anterior cruciate ligament reconstruction demonstrated weaker knee muscles compared to their asymptomatic counterparts. The comparable walking and forward lunge biomechanics suggest that knee pain has no substantial impact on movement biomechanics up to 10 years post-surgery.

LEVEL OF EVIDENCE: Level III.