Journal of Orthopaedic Research

Individuals following anterior cruciate ligament reconstruction practice underloading strategies during daily activity

Ming-Sheng Chan, Susan M. Sigward

Meyer Institute of Sport, Los Angeles,


acl, daily acitivity


Underloading the surgical limb has been described in biomechanical studies across recovery time points following anterior cruciate ligament reconstruction (ACLr). This study aimed to examine the extent to which laboratory findings translate to daily activities. Limb loading was quantified during a sit-to-stand task in laboratory testing and throughout 2 days of daily activity in 15 individuals 114.8 (17.2) days post-ACLr and 15 controls. Vertical force impulse calculated from force platform (laboratory) and pressure insoles (daily) was used to quantify limb loading. Between-limb symmetry was calculated for limb loading and knee strength measures, 2 × 2 GLM repeated measures determined a significant group-by-limb interaction on daily limb loading. Surgical limb daily loading was lower compared to nonsurgical (p < .001; effect sizes [ES] = 0.63), and control matched limbs (surgical: p = .037, ES = 0.80 and nonsurgical: p = .02, ES = 0.89). No group differences were found in total daily loading (summed loading between limbs; p = .18; ES = 0.50) and time performing weight-bearing activities (p = .32; ES = 0.36). Pearson's correlation determined that between-limb symmetry in daily loading was related to sit-to-stand loading (r = .62; p = .01) and knee extensor strength symmetry (r = .6; p = .02) in the ACLr group. These data support the presence of underloading behaviors in individuals 10–14 weeks following ACLr that are consistent with previous biomechanical studies and current biomechanical data. Knee extensor weakness was related to greater underloading. Asymmetrical loading quantified in the laboratory is practiced throughout the day in individuals post-ACLr. Practice afforded by daily activities represents powerful contributors to learning of a pattern that contrasts the goal of rehabilitation exercises.

Moticon's Summary

In this study the authors aimed at investigating loading strategies of the surgical limb after an anterior cruciate ligament reconstruction. Underloading of the surgical limb was monitored using data derived from Moticon sensor insoles and force plates during daily activities. Computed vertical force impulse showed the presence of underloading in daily activities thereby demonstrating the potential of sensor insoles in monitoring rehabilitation.

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