Knee biomechanics during rehabilitation exercise in individuals with and without anterior cruciate ligament reconstruction: A systematic review

Background

Post-traumatic osteoarthritis rates are similar in individuals with anterior cruciate ligament injury who receive surgical reconstruction and those who opt for non-surgical management, indicating continuing changes in knee biomechanics post-surgery. There is no gold standard rehabilitation strategy for the post-reconstruction patient, however investigating the biomechanics of the knee during rehabilitation exercises will drive the development of more efficacious rehabilitation paradigms. This systematic review aimed to synthesise biomechanical data from healthy participants and participants with anterior cruciate ligament reconstruction during rehabilitation exercises to provide insights into knee biomechanical changes induced by injury and surgery.

Methods

A systematic literature search was conducted in Web of Science, MEDLINE, EMBASE, PubMed, CINAHL and Scopus, using key terms relating to anterior cruciate ligament reconstruction, lower limb rehabilitation exercises, and knee biomechanics. 34 articles matching the inclusion criteria were identified following abstract and full text screening.

Findings

The included studies reported data on 607 healthy participants and 175 participants with an anterior cruciate ligament reconstruction across five different exercises. Peak knee flexion angle was the most reported variable, whereas tibial anterior translation and adduction biomechanics were reported infrequently, despite their relevance to the ligament injury status.

Interpretation

There is limited biomechanical data of rehabilitation exercise in the knee, with the exception of knee flexion angles. Furthermore, variations in data collection and reporting methods across studies cause difficulties in systematic analysis of results and demonstrate inconsistent kinematic results between articles.