Knee hyperextension gait abnormalities in unstable knees: Recognition and preoperative gait retraining

Frank R. Noyes, Laura A. Dunworth, Thomas P. Andriacchi, Michelle Andrews, Timothy Hewett

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion patterns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79% decrease in extension moments at terminal extension, and a 22% decrease in knee adduction moments. Posttraining values also showed a 30% decrease in the calculated medial tibiofemoral loads (P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36% and 18%, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42% (P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruction because abnormal knee motions, if resumed postoperatively, can stretch soft tissue reconstructions.

Original languageEnglish (US)
Pages (from-to)35-45
Number of pages11
JournalAmerican Journal of Sports Medicine
Volume24
Issue number1
StatePublished - Jan 1996
Externally publishedYes

Fingerprint

Gait
Knee
Ankle
Hip
Ligaments
Biomechanical Phenomena
Walking
Wounds and Injuries

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Knee hyperextension gait abnormalities in unstable knees : Recognition and preoperative gait retraining. / Noyes, Frank R.; Dunworth, Laura A.; Andriacchi, Thomas P.; Andrews, Michelle; Hewett, Timothy.

In: American Journal of Sports Medicine, Vol. 24, No. 1, 01.1996, p. 35-45.

Research output: Contribution to journalArticle

Noyes, Frank R. ; Dunworth, Laura A. ; Andriacchi, Thomas P. ; Andrews, Michelle ; Hewett, Timothy. / Knee hyperextension gait abnormalities in unstable knees : Recognition and preoperative gait retraining. In: American Journal of Sports Medicine. 1996 ; Vol. 24, No. 1. pp. 35-45.
@article{18a8c5c6f8b64b888c61e11d4d780893,
title = "Knee hyperextension gait abnormalities in unstable knees: Recognition and preoperative gait retraining",
abstract = "Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion patterns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79{\%} decrease in extension moments at terminal extension, and a 22{\%} decrease in knee adduction moments. Posttraining values also showed a 30{\%} decrease in the calculated medial tibiofemoral loads (P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36{\%} and 18{\%}, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42{\%} (P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruction because abnormal knee motions, if resumed postoperatively, can stretch soft tissue reconstructions.",
author = "Noyes, {Frank R.} and Dunworth, {Laura A.} and Andriacchi, {Thomas P.} and Michelle Andrews and Timothy Hewett",
year = "1996",
month = "1",
language = "English (US)",
volume = "24",
pages = "35--45",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Inc.",
number = "1",

}

TY - JOUR

T1 - Knee hyperextension gait abnormalities in unstable knees

T2 - Recognition and preoperative gait retraining

AU - Noyes, Frank R.

AU - Dunworth, Laura A.

AU - Andriacchi, Thomas P.

AU - Andrews, Michelle

AU - Hewett, Timothy

PY - 1996/1

Y1 - 1996/1

N2 - Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion patterns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79% decrease in extension moments at terminal extension, and a 22% decrease in knee adduction moments. Posttraining values also showed a 30% decrease in the calculated medial tibiofemoral loads (P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36% and 18%, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42% (P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruction because abnormal knee motions, if resumed postoperatively, can stretch soft tissue reconstructions.

AB - Five patients with symptomatic knee hyperextension thrusting patterns due to posterolateral ligament complex injury underwent gait analysis before and after a gait retraining program. Patients were trained to avoid knee hyperextension by 1) walking with their knees slightly flexed throughout stance, 2) maintaining ankle dorsiflexion in early stance, and 3) maintaining an erect trunk-hip attitude during stance. Kinematic and kinetic measurements were obtained using automated gait analysis. Four of the five patients significantly reduced hyperextension at the knee and abnormal motion patterns at the hip and ankle. Patients showed increases in knee flexion throughout stance conversions of knee flexion-extension moments to more normal biphasic patterns with a 79% decrease in extension moments at terminal extension, and a 22% decrease in knee adduction moments. Posttraining values also showed a 30% decrease in the calculated medial tibiofemoral loads (P < 0.05). At the hip, there were significant decreases in abduction and adduction moments (36% and 18%, respectively, P < 0.01). Ankle plantar flexion motion decreased significantly by 42% (P < 0.01). Gait retraining can alter the biomechanics of hip, knee, and ankle function to approximately normal levels, and therefore is recommended before ligament reconstruction because abnormal knee motions, if resumed postoperatively, can stretch soft tissue reconstructions.

UR - http://www.scopus.com/inward/record.url?scp=0030032594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030032594&partnerID=8YFLogxK

M3 - Article

C2 - 8638751

AN - SCOPUS:0030032594

VL - 24

SP - 35

EP - 45

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 1

ER -