Clinical Practice And Perspectives On Addressing Biomechanical Maladaptations After Anterior Cruciate Ligament Reconstruction And A Potential Novel Solution

Authors

• Kyle Southall, University of Alabama at Birmingham

Advisor(s)

Christopher Hurt

Committee Member(s)

C Scott Bickel
Harshvardhan Singh
Laura Vogtle
Matthew Ithurburn
Megan Bell

School

School of Health Professions

Document Type

Dissertation

Department (new version)

Physical Therapy

Date of Award

9-9-2024

Abstract

Gait is one of the most daily cyclic events an otherwise healthy human will experience. After an orthopedic injury such as an anterior cruciate ligament (ACL) injury that is commonly reconstructed (ACLR), gait can be largely affected, both acutely after injury, and long-term affecting the long-term knee health of the individual. As those individuals who sustain an ACL injury and subsequent reconstruction are commonly young, typically in their teens to early 30 years of age, the long-term effects of an ACLR procedure can have decades of impact on their respective quality of life. This dissertation used a variety of experimental designs and analytical processes to gain a better understanding of how gait can influence the long-term knee health of an individual who has undergone an ACLR procedure. We first performed a rigorous scoping review to systematically evaluate the body of scientific knowledge on therapeutic interventions that directly affected gait metrics that are hypothesized to affect long-term knee health. We found that the body of literature on these therapeutic interventions is very small. We then surveyed practicing rehabilitation clinicians and found while many respondents reported gait being an important aspect of the rehabilitation of an individual with an ACLR procedure, very few were objectively measuring gait. We also found that very few respondents were utilizing the therapeutic interventions found in our first project. Then using the information found in the literature and clinical practice, we developed a novel therapeutic intervention of walking against varying posteriorly directed resistive forces applied to the center of mass of an individual. This novel therapeutic intervention can directly affect a modifiable risk factor of osteoarthritis (OA) such as gait maladaptations common in individuals post ACLR while also providing a task specific strengthening exercise. Combined, these various aspects gave us a better understanding of the current body of literature regarding the therapeutic interventions post ACLR procedure, provided insight to current clinical practices, and informed development of a prospective novel therapeutic intervention for those with a recently ACLR procedure. These findings support and inform the future direction towards the greater objective of preserving long-term knee health in individuals who have undergone an ACLR procedure.

ProQuest ID

https://proquest.com/docview/3101842604