Pre and post operative gait analysis in patients undergoing anterior cruciate ligament reconstruction using patellar tendon bone graft– a one year hospital based observational study

Abstract

INTRODUCTION: • Gait defines as the locomotion achieved by movement of human limbs. In humans it is achieved by bi-pedal and bi-phasic forward propulsion which has meandrous movements with least possible expense of energy. • Gait has three components : 1. Progression 2. Stability 3. Energy conservation 1. PROGRESSION: The primary force created by lower limb to attain forward fall of body weight while maintaining secondary momentum generated by upper limb through swinging motion. 2. STABILITY: The forward fall is then controlled throughout the phase of the gait while maintaining in upright position. During the stance phase the body is most stable where the ankle, hip and knee are vertically aligned, the stability is maintained by strong ligaments of the hip and knee. The balance between the knee stability and shock absorption is maintained by contraction of quadriceps. 3. ENERGY CONSERVATION: It is calculated by oxygen consumed per meter travelled. Human gait enhances this by reducing the quantity of muscular effort which is required for walking. This is achieved by co-ordinated pelvic, knee and ankle motion. • The ligaments of hip and knee play a vibrant role in gait, any injury to these ligaments will alter the pattern of the gait. • Anterior cruciate ligament is commonly injured and associated with instability of knee which results in alteration in normal pattern of the gait. • As arthroscopic surgeries for ACL ligament injury emerged in the late 1990’s. The analysis regarding gait pattern post reconstruction of ACL has been given a faint importance. • The instability of post ACL injury is due to change in biomechanics of knee as tibia overrides the femur anteriorly while reclining downstairs or walking on uneven surfaces. • After introducing 3D-locomotory gait analyser, there has been a profound use of this system to analyse the discrepancy in the pattern of gait in ACL injury as well as post ACL reconstruction. • The emergence of this system has been a helpful boon for the patients who have undergone ACL reconstructive surgery to revert to their normal gait pattern. • The graft selection for ACL reconstruction has numerous options which comprises of bone patellar tendon bone graft, hamstring graft, allografts and synthetic grafts. • Among these bone-patellar tendon-bone graft (BPTB) has high tensile strength and quicker healing capabilities. Though it has post-operative donor site morbidity, the merits for reconstruction of ACL with BPTB graft is comparatively better to its demerits.