Ligamentos Curados

Acta of Bioengineering and Biomechanics Original paper

Vol. 14, No. 2, 2012 DOI: 10.5277/abb120212

Evaluation of gait kinematics and symmetry

during the first two stages of physiotherapy

after anterior cruciate ligament reconstruction

SŁAWOMIR WINIARSKI1, 2*, ANDRZEJ CZAMARA1

1 Centre of Rehabilitation, University College of Physiotherapy, Wrocław, Poland.

2 Department of Biomechanics, University School of Physical Education, Wrocław, Poland.

One of the primary goals of physiotherapy after anterior cruciate ligament (ACL) reconstruction is to restore of the patient’s normal

gait patterns. However, to date, only a limited number of studies have examined gait during physiotherapeutic procedures following ACL

reconstruction. Thus, the objective of the present study was to evaluate gait kinematics and symmetry in male patients after ACL reconstruction

during the first two stages of their physiotherapy programme.

Ninety-seven males, including 53 patients after primary ACL reconstruction in one limb and 44 healthy controls, participated in the

study. The patients were examined using a movement analysis system during their physiotherapeutic programme (from the 2nd to the

12th week following reconstruction). Some selected parameters of gait kinematics, a dynamic range of movement in the knee joint and gait

asymmetry coefficients were evaluated. During the 12th week of physiotherapy, a mean gait velocity increased by more than 0.97 m/s compared

to that obtained during the 2nd week of physiotherapy. A statistically significant increase in the relative length of stance phase was

observed in the involved extremity, from 36.1% to 62.7% (P = 0.01); the range of movement significantly improved from 25.8 degrees

during the 2nd week to 63.7 degrees during the 12th week of physiotherapy. At the same time, the stance time asymmetry coefficient

decreased from 68.5% to –0.4%.

We observed a significant improvement in most of the gait parameters from the 2nd to the 12th week of physiotherapy after reconstruction

and also in comparison to the results obtained for the control group.

Key words: gait analysis, asymmetry, anterior cruciate ligament (ACL), reconstruction, physiotherapy assessment

1. Introduction

Gait is one of the basic and most effective ways of

human locomotion involving motion of the body mass

centre along a track, with the lowest possible energy

expenditure [1]. It is a motive, cyclic and alternant

movement of the lower limbs, accompanied by asynchronous

movements of the upper limbs. The movements

of the right and left body sides with individual

lateralisation should be relatively symmetric in terms of

time and space [2]. This form of locomotion is subject

to complex control at different levels of the nervous

system and is characterised by precise neuromuscular

coordination [3], [4]. Numerous monographies have

been dedicated to the subject of gait. Indeed, VAUGHAN

et al. [5] reported in 2005 that there were over 6,500

publications and textbooks on gait analysis. The standard

evaluation of gait consists of an initial subjective

visual assessment and the assessment of gait components.

Objective methods are in turn applied to measure

the kinematic and kinetic parameters of gait [6]–

[8], ground reaction force components [9]–[12], muscular

activity [12], energy expenditure and other

physiological parameters [13]. Gait symmetry evaluation

is a separate issue as it is based on asymmetry

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* Corresponding author: Sławomir Winiarski, Centre of Rehabilitation, University College of Physiotherapy, Kościuszki 4, 50-038 Wrocław,

Poland. Tel/fax: +48 71 3425002, e-mail: s.winiarski@wsf.wroc.pl

Received: September 20th, 2011

Accepted for publication: March 20th, 2012

92 S. WINIARSKI, A. CZAMARA

indices [14], [15]. Symmetry indices are used

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