Anterior Cruciate Ligament Reconstruction Rehabilitation Utilizing Gait Metrics as Outcomes - A Scoping Review.

Background: There is a growing body of knowledge linking common gait maladaptations seen in patients who have undergone an anterior cruciate ligament repair (ACLR) procedure and early-onset OA of the knee. These maladaptations present during the early stages of recovery following ACLR and often persist up to five to seven years, and likely beyond, after surgery. Purpose: The purpose of this scoping review was to investigate the literature on therapeutic interventions after ACLR whose purpose is to normalize gait biomechanics. Study Design: Scoping Review. Methods: PubMed, SPORTDiscus, CINAHL, Embase, and Scopus databases were searched using predefined terms such as Anterior Cruciate Ligament, Gait, Locomotion. Two authors independently reviewed abstracts and full texts. Inclusion criteria included: 1) articles published between 1990 and 2023, 2) written in English, 3) conducted using human participants, 4) full text available, 5) included participants who were between the ages of 18-35 years and had undergone an ACLR procedure within five years of the relevant intervention, and 6) included outcomes measures focused on walking/gait metrics after receiving a therapeutic intervention. Exclusion criteria were Case studies, case series, and studies using non-living subjects, such as animal studies or human cadaver studies. Results: Of the 2873 potential studies 14 studies including 404 participants met all criteria. Six studies included targeted strengthening as an adjunct to a normal ACLR rehabilitation protocol, two included partial bodyweight training via treadmill, three included assistive devices for gait or real time feedback via assistive devices, two included vibration therapy, and one included a harmonic oscillator intervention. The high variability of interventions on a limited number of participants makes it difficult to generalize their applicability in the clinical setting on a large scale. Especially as few studies have evaluated the effects of interventions specifically on gait metrics. Conclusion: There is a noted lack of standardization of prospective interventions to normalize gait after ACLR that also includes a long-term follow-up. These interventions are important to potentially help preserve long-term knee health in individuals with ACLR. There is a present need for rigorous therapeutic intervention that addresses common gait maladaptations after ACLR to potentially help preserve the long-term knee health in individuals with ACLR. Level of Evidence: 2.