Systematic review and meta analysis on aberrant gait during treadmill walking after anterior cruciate ligament reconstruction

doi:10.3877/cma.j.issn.1674-134X.2021.03.008

Abstract

Abstract:

Objective

To systematic analyze gait of operated limb after anterior cruciate ligament reconstruction, compared with contralateral limb or healthy control limb.

Methods

A comprehensive retrieve was performed in Pubmed, Web of Since, Cochrane Library, China National Knowledge Internet(CNKI), Viper database and China Biology Medicine (CBM) in March 1, 2021, with subject term and keywords focusing on "anterior cruciate ligament injury" "surgery" 、"anterior cruciate ligament reconstruction" 、"biometrics" 、"gait analysis" and "kinematics" and language restricted to English or Chinese. Articles were finally included after screened of titles, abstracts and full texts by two researchers. After data extraction and methodological quality evaluation, a statistic analysis was performed with RevMan 5.3.

Results

A total of 35 articles including 925 ACLR patients and 241 healthy control participants met the inclusion criteria finally. Compared with contralateral limbs or healthy control limbs, operated limbs showed smaller peak knee flexion angle [mean deviation (MD)=-1.19, 95%confidence interval(CI)(-1.96, -0.42), P=0.002], knee flexion moment [MD=-0.06, 95%CI(-0.12, 0), P=0.04], knee extension moment [MD=-0.01, 95%CI(-0.01, 0), P=0.04] and peak vertical ground react force [MD=-0.03, 95%CI(-0.04, -0.01), P=0.0003].

Conclusion

Aberrant gait of operated limb during treadmill walking could exist in long term after anterior cruciate ligament reconstruction, including smaller peak knee flexion angle, knee flexion moment, knee extension moment as well as peak vertical ground react force.

Key words: Anterior cruciate ligament reconstruction, Biomechanical Phenomena, Gait, Meta analysis

Tianping Zhou, Yihong Xu, Weidong Xu. Systematic review and meta analysis on aberrant gait during treadmill walking after anterior cruciate ligament reconstruction[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(03): 307-317.

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Figures/Tables 9

References 49

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第一作者	发表时间	国家	例数(男/女)		移植物类型	随访时间	结局指标	NOS评分
第一作者	发表时间	国家	ACLR组	健康对照组	移植物类型	随访时间	结局指标	NOS评分
Shimizu^[2]	2020	美国	20/16	9/5	24HT，12ST	3年	pKFA、pKFM、vGRF	9
Blackburn^[5]	2019	美国	20/52	无	41PT，25HT，3QT, 3AT	(27±16)个月	pKFA、pKEM、pKVrA、pKVrM、vGRF	7
Davis-Wilson^[6]	2019	美国	16/16	无	PT	1年	pKFA、vGRF	7
Lin^[7]	2018	美国	7/13	无	PT，HT	(112±17)d	pKEM、vGRF	6
Pfeiffer^[8]	2018	美国	14/15	无	PT	6个月	pKEM、vGRF	7
Johnston^[9]	2019	美国	5/19	无	HT	(43±34)个月	pKFA、pKEM、pKVrA、pKVgM、vGRF	6
			29/45	无	PT	(22±26)个月	pKFA、pKEM、pKVrA、pKVgM、vGRF	6
Pamukoff^[10]	2018	美国	0/25	无	14PT，8HT，3AT	(60.6±24.8)个月	pKFA、pKFM、pKVrA、pKVrM、vGRF	6
Lin^[11]	2018	美国	10/20	无	14PT，3HT，2QT, 11AT	(108±17)d	pKEM、vGRF	6
Shi^[12]	2018	中国	25/0	无	HT	(7.4±1.3)个月	pKFA、pKVrA、pKVrM、pKVgM	7
Luc-Harkey^[13]	2018	美国	9/21	无	16HT，14PT	(47.83±26.97)个月	pKEM、vGRF	7
Pietrosimone^[14]	2018	美国	13/12	无	HT，PT	6个月	vGRF	6
Capin^[15]	2018	美国	35/0	无	19HT，8PT，8AT	2年	pKFA、pKEM	8
Pfeiffer^[16]	2018	美国	9/26	无	HT，PT	4年	pKFA、pKEM、pKVrA、pKVgM、vGRF	7
Erhart-Hledik^[17]	2017	美国	42	17	HT，PT	(7.7±0.7)年	pKFA、pKErA、pKVgA	7
Teng^[18]	2017	美国	20/13	8/4	HT，PT	1年	pKFA、pKFM、vGRF	7
Blackburn^[19]	2016	美国	29	无	HT，PT	(48±41)个月	vGRF	6
Pietrosimone^[20]	2015	美国	11/8	无	HT，PT	(31±29)个月	vGRF	7
Patterson^[21]	2014	美国	17	17	HT，PT	3.5年	pKVrM	6
White^[22]	2013	美国	30/10	无	HT，PT	1年	pKFA、pKFM、pKEM	7
Hall^[23]	2012	美国	7/8	7/10	HT，PT	6年	pKFM、pKVrA	6
Webster^[24]	2011	美国	18/18	无	HT，PT	(13.1±9.0)个月	pKFA、pKFM、pKVrA、pKVrM	7
Roewer^[25]	2011	美国	18/8	无	HT，PT	2年	pKFA	7
Lewek^[26]	2002	美国	18	10	HT	5个月	pKFA、pKFM	6
李锐^[27]	2018	中国	0/5	无	HT	(4.4±2.1)个月	vGRF	5
Bulter^[28]	2009	美国	4/13	4/13	HT，PT	(5.3±4.4)年	pKVrA、pKVrM、vGRF	8
Webster^[29]	2012	美国	13/3	无	HT，PT	(3.3±0.4)年	pKFA、pKFM、pKEM、pKIrA、pKVrA、pKVrM	6
Wang^[30]	2013	美国	14/10	15/5	HT，PT	(8.8±4.3)个月	pKFA、pKErA、pKVrA	7
Zabala^[31]	2013	美国	26/19	26/19	HT，PT，AT	26个月	pKFM、pKErM、pVrM	7
Shin^[32]	2009	美国	15/9	无	HT，PT，AT	34个月	pKFM、pKIrM、pKErM、pKVrA、PKVgA	7
Asaeda^[33]	2017	美国	16/16	16/16	HT，PT，AT	12个月	pKFA、pKEM、pKIrA、pKErA、pKVrA	7
Czamara^[34]	2015	波兰	23	15	HT，PT	(13.6±3.27)周	pKErA	6
Georgoulis^[35]	2003	美国	19/2	8/2	HT，PT	(30±16.9)周	pKFA、pKErA、pKVrA	6
Sato^[36]	2013	日本	3/4	无	HT，PT	(14.3±1.8)个月	pKIrM	5
Goetschius^[37]	2018	美国	13/23	7/13	HT，PT	(8.6±2.8)年	pKFM、pKEM、pKVrA、pKVrM	6

第一作者	发表时间	国家	例数(男/女)		移植物类型	随访时间	结局指标	NOS评分
第一作者	发表时间	国家	ACLR组	健康对照组	移植物类型	随访时间	结局指标	NOS评分
Shimizu^[2]	2020	美国	20/16	9/5	24HT，12ST	3年	pKFA、pKFM、vGRF	9
Blackburn^[5]	2019	美国	20/52	无	41PT，25HT，3QT, 3AT	(27±16)个月	pKFA、pKEM、pKVrA、pKVrM、vGRF	7
Davis-Wilson^[6]	2019	美国	16/16	无	PT	1年	pKFA、vGRF	7
Lin^[7]	2018	美国	7/13	无	PT，HT	(112±17)d	pKEM、vGRF	6
Pfeiffer^[8]	2018	美国	14/15	无	PT	6个月	pKEM、vGRF	7
Johnston^[9]	2019	美国	5/19	无	HT	(43±34)个月	pKFA、pKEM、pKVrA、pKVgM、vGRF	6
			29/45	无	PT	(22±26)个月	pKFA、pKEM、pKVrA、pKVgM、vGRF	6
Pamukoff^[10]	2018	美国	0/25	无	14PT，8HT，3AT	(60.6±24.8)个月	pKFA、pKFM、pKVrA、pKVrM、vGRF	6
Lin^[11]	2018	美国	10/20	无	14PT，3HT，2QT, 11AT	(108±17)d	pKEM、vGRF	6
Shi^[12]	2018	中国	25/0	无	HT	(7.4±1.3)个月	pKFA、pKVrA、pKVrM、pKVgM	7
Luc-Harkey^[13]	2018	美国	9/21	无	16HT，14PT	(47.83±26.97)个月	pKEM、vGRF	7
Pietrosimone^[14]	2018	美国	13/12	无	HT，PT	6个月	vGRF	6
Capin^[15]	2018	美国	35/0	无	19HT，8PT，8AT	2年	pKFA、pKEM	8
Pfeiffer^[16]	2018	美国	9/26	无	HT，PT	4年	pKFA、pKEM、pKVrA、pKVgM、vGRF	7
Erhart-Hledik^[17]	2017	美国	42	17	HT，PT	(7.7±0.7)年	pKFA、pKErA、pKVgA	7
Teng^[18]	2017	美国	20/13	8/4	HT，PT	1年	pKFA、pKFM、vGRF	7
Blackburn^[19]	2016	美国	29	无	HT，PT	(48±41)个月	vGRF	6
Pietrosimone^[20]	2015	美国	11/8	无	HT，PT	(31±29)个月	vGRF	7
Patterson^[21]	2014	美国	17	17	HT，PT	3.5年	pKVrM	6
White^[22]	2013	美国	30/10	无	HT，PT	1年	pKFA、pKFM、pKEM	7
Hall^[23]	2012	美国	7/8	7/10	HT，PT	6年	pKFM、pKVrA	6
Webster^[24]	2011	美国	18/18	无	HT，PT	(13.1±9.0)个月	pKFA、pKFM、pKVrA、pKVrM	7
Roewer^[25]	2011	美国	18/8	无	HT，PT	2年	pKFA	7
Lewek^[26]	2002	美国	18	10	HT	5个月	pKFA、pKFM	6
李锐^[27]	2018	中国	0/5	无	HT	(4.4±2.1)个月	vGRF	5
Bulter^[28]	2009	美国	4/13	4/13	HT，PT	(5.3±4.4)年	pKVrA、pKVrM、vGRF	8
Webster^[29]	2012	美国	13/3	无	HT，PT	(3.3±0.4)年	pKFA、pKFM、pKEM、pKIrA、pKVrA、pKVrM	6
Wang^[30]	2013	美国	14/10	15/5	HT，PT	(8.8±4.3)个月	pKFA、pKErA、pKVrA	7
Zabala^[31]	2013	美国	26/19	26/19	HT，PT，AT	26个月	pKFM、pKErM、pVrM	7
Shin^[32]	2009	美国	15/9	无	HT，PT，AT	34个月	pKFM、pKIrM、pKErM、pKVrA、PKVgA	7
Asaeda^[33]	2017	美国	16/16	16/16	HT，PT，AT	12个月	pKFA、pKEM、pKIrA、pKErA、pKVrA	7
Czamara^[34]	2015	波兰	23	15	HT，PT	(13.6±3.27)周	pKErA	6
Georgoulis^[35]	2003	美国	19/2	8/2	HT，PT	(30±16.9)周	pKFA、pKErA、pKVrA	6
Sato^[36]	2013	日本	3/4	无	HT，PT	(14.3±1.8)个月	pKIrM	5
Goetschius^[37]	2018	美国	13/23	7/13	HT，PT	(8.6±2.8)年	pKFM、pKEM、pKVrA、pKVrM	6

项目	纳入文献(篇)	异质性检验		模型	合并效应量
项目	纳入文献(篇)	I²	P值	模型	MD	95%CI	P值
支撑相膝关节最大内收角度(术后1年内)	3	0.00	1.00	固定效应	0.43	(-0.37，1.24)	0.29
支撑相膝关节最大内收角度(术后1年后)	13	0.00	0.81	固定效应	0.00	(-0.10，0.11)	0.93
支撑相膝关节最大外翻角度	2	0.15	0.31	固定效应	-0.17	(-0.39，0.05)	0.14
支撑相膝关节最大内旋角度	3	0.52	0.10	固定效应	-0.45	(-1.82，0.93)	0.53
支撑相膝关节最大外旋角度	5	0.54	0.04	随机效应	0.00	(-0.89，0.90)	0.99

项目	纳入文献(篇)	异质性检验		模型	合并效应量
项目	纳入文献(篇)	I²	P值	模型	MD	95%CI	P值
支撑相膝关节最大内收角度(术后1年内)	3	0.00	1.00	固定效应	0.43	(-0.37，1.24)	0.29
支撑相膝关节最大内收角度(术后1年后)	13	0.00	0.81	固定效应	0.00	(-0.10，0.11)	0.93
支撑相膝关节最大外翻角度	2	0.15	0.31	固定效应	-0.17	(-0.39，0.05)	0.14
支撑相膝关节最大内旋角度	3	0.52	0.10	固定效应	-0.45	(-1.82，0.93)	0.53
支撑相膝关节最大外旋角度	5	0.54	0.04	随机效应	0.00	(-0.89，0.90)	0.99

项目	纳入文献(篇)	异质性检验		模型	合并效应量
项目	纳入文献(篇)	I²	P值	模型	MD	95%CI	P值
膝关节内收力矩	10	0.23	0.002	随机效应	-0.01	(-0.04，0.03)	0.70
膝关节外翻力矩	2	0.15	0.31	固定效应	-0.17	(-0.39，0.05)	0.14
膝关节内旋力矩	2	0.76	0.04	随机效应	-1.96	(-6.76，2.84)	0.42
膝关节外旋力矩	2	0.00	0.64	固定效应	-0.04	(-0.08，0.00)	0.07

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