Gait adaptation in chronic anterior cruciate ligament-deficient patients: Pivot-shift avoidance gait

Background: A variety of biomechanical adaptations of the knee during gait have been reported in ACL-deficient patients to cope with anteroposterior knee instability. However, strategies to prevent rotatory knee instability are less recognized. We hypothesized that ACL-deficient patients would make distinctive gait changes to prevent anterolateral rotatory knee instability. Specifically, we hypothesized that during the terminal stance phase of the gait cycle, ACL-deficient patients would reduce the internal rotation knee joint moment and exhibit a higher knee flexion angle. We call this altered gait a pivot-shift avoidance gait. We also hypothesized that patients would not be able to adapt their knee biomechanics as efficiently at a fast gait speed. Methods: Twenty-nine patients with chronic ACL deficiency and 15 healthy volunteers took part in a treadmill gait analysis. The terminal stance phase was analyzed under both comfortable and fast gait speed conditions. Findings: At both gait speeds, ACL-deficient patients significantly reduced the internal rotation knee joint moment and showed larger knee flexion angles during the terminal stance phase of the gait cycle than did the control group. However, the difference in the minimum knee flexion angle between groups under the fast gait speed condition was not statistically significant. Interpretation: ACL-deficient patients adopted the proposed pivot-shift avoidance gait, possibly to prevent anterolateral rotatory knee instability. The patients were not able to adapt their knee biomechanics as effectively during fast-paced walking. This study reinforces the pertinence of gait analysis in ACL-deficient knees to acquire more information about the function of the knee joint. (C) 2010 Elsevier Ltd. All rights reserved.