Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction

Early Gait Biomechanics Linked to Daily Steps After Anterior Cruciate Ligament Reconstruction

CONTEXT

Gait biomechanics and daily steps are important aspects of knee-joint loading that change after anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help clinicians develop comprehensive rehabilitation interventions that promote optimal joint loading after injury, thereby improving long-term knee-joint health.

OBJECTIVES

To compare biomechanical gait waveforms throughout stance at early time points post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR and to examine how these gait waveforms compare with those of uninjured controls.

DESIGN

Case-control study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 32 individuals with primary ACLR assigned to the low-step group (LSG; n = 13) or the high-step group (HSG; n = 19) based on their average daily steps at 6 months post-ACLR and 32 uninjured matched controls.

MAIN OUTCOME MEASURE(S)

Gait biomechanics were collected at 2, 4, and 6 months post-ACLR for the ACLR groups and at a single session for the control group. Knee-adduction moment, knee-extension moment (KEM), and knee-flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% CIs between groups were reported.

RESULTS

Primary results demonstrated less KFA (1%-45% versus 79%-92% of stance) and greater KEM (65%-93% of stance) at 2 months and greater knee-adduction moment (14%-20% versus 68%-92% of stance) at 4 months post-ACLR for the HSG compared with the LSG. Knee-adduction moment, KEM, and KFA waveforms differed across various proportions of stance at all time points between the step and control groups.

CONCLUSIONS

Differences in gait biomechanics were present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily step behaviors post-ACLR.

Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Objective

To compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR) and healthy control group.

Design

Systematic review and meta-analysis of observational studies.

Data sources

Web of Science, Scopus, and PubMed have been comprehensively searched to identify relevant investigations.

Eligibility criteria for selecting studies

An observational research that objectively evaluated physical activity among respondents with a history of ACLR.

Results

Of 302 records, a total of 12 studies fulfilled the eligibility criteria. Four hundred and forty-three participants underwent the ACLR, 153 men and 290 women. The mean time between anterior cruciate ligament (ACL) surgery and evaluation of analysed outcomes was 34.8 months. The main findings demonstrated that the ACLR group spent less time in weekly MVPA (standardised mean differences (SMD)=-0.43 (95% CI -0.66 to -0.20); mean = -55.86 min (95% CI -86.45 to -25.27); p=0.0003; τ2=0.00), in daily MVPA (SMD=-0.51 95% CI -0.76 to -0.26]; mean = -15.59 min (95% CI -22.93 to -8.25); p<0.0001; τ2=0.00), and they had fewer daily steps (SMD=-0.60 95% CI -0.90 to -0.30); mean = -1724.39 steps (95% CI -2552.27 to -896.50); p<0.0001; τ2=0.00) relative to their non-injured counterparts. Additionally, available investigations indicated that individuals with a history of ACLR participated in 316.8 min of MVPA per week, 67 min in MVPA per day, and 8337 steps per day.

Conclusion

Long-term after ACLR, participants undergoing ACL surgery were less physically active compared with their non-injured peers, and they did not satisfy recommendations regarding steps per day.

PROSPERO registration number

CRD42023431991.

Monitoring External Workload With Wearable Technology After Anterior Cruciate Ligament Reconstruction: A Scoping Review

Background

Current sports medicine and rehabilitation trends indicate an increasing use of wearable technology. The ability of these devices to collect, transmit, and process physiological, biomechanical, bioenergy, and environmental data may aid in anterior cruciate ligament reconstruction (ACLR) workload monitoring and return-to-sport decision-making. In addition, their ease of use allows assessments to occur outside the clinical or laboratory settings and across a broader timeline.

Purpose

To (1) determine how wearable technology can assess external workload deficits between limbs (involved and uninvolved) and between groups (healthy controls vs patients with ACLR) during physical activity (PA) or sport and (2) describe the types of sensors, sensor specifications, assessment protocols, outcomes of interest, and participant characteristics from the included studies.

Study Design

Scoping review; Level of evidence, 4.

Methods

In February 2023, a systematic search was performed in the MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, IEEE Xplore, Compendex, and ProQuest Dissertations and Theses Global databases. Eligible studies included assessments of PA or sports workloads via wearable technology after ACLR.

Results

Twenty articles met eligibility criteria and were included. The primary activity assessed was activities of daily living, although rehabilitation, training, and competition were also represented. Accelerometers, global positioning system units, pedometers, and pressure sensor insoles were worn to collect external workload data, which was quantified as kinetic, kinematic, and temporospatial data. Daily steps (count) and moderate to vigorous PA (min/day or week) were the most common units of measurement. A limited number of studies included outcomes related to between-limb asymmetries.

Conclusion

The findings of this scoping review highlight the versatility of wearable technologies to collect patients' kinetic, kinematic, and temporospatial data and assess external workload outcomes after ACLR. In addition, some wearable technologies identified deficits in workload compared with healthy controls and between reconstructed and unaffected limbs.

A scoping review of portable sensing for out-of-lab anterior cruciate ligament injury prevention and rehabilitation

Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) surgery are common. Laboratory-based biomechanical assessment can evaluate ACL injury risk and rehabilitation progress after ACLR; however, lab-based measurements are expensive and inaccessible to most people. Portable sensors such as wearables and cameras can be deployed during sporting activities, in clinics, and in patient homes. Although many portable sensing approaches have demonstrated promising results during various assessments related to ACL injury, they have not yet been widely adopted as tools for out-of-lab assessment. The purpose of this review is to summarize research on out-of-lab portable sensing applied to ACL and ACLR and offer our perspectives on new opportunities for future research and development. We identified 49 original research articles on out-of-lab ACL-related assessment; the most common sensing modalities were inertial measurement units, depth cameras, and RGB cameras. The studies combined portable sensors with direct feature extraction, physics-based modeling, or machine learning to estimate a range of biomechanical parameters (e.g., knee kinematics and kinetics) during jump-landing tasks, cutting, squats, and gait. Many of the reviewed studies depict proof-of-concept methods for potential future clinical applications including ACL injury risk screening, injury prevention training, and rehabilitation assessment. By synthesizing these results, we describe important opportunities that exist for clinical validation of existing approaches, using sophisticated modeling techniques, standardization of data collection, and creation of large benchmark datasets. If successful, these advances will enable widespread use of portable-sensing approaches to identify ACL injury risk factors, mitigate high-risk movements prior to injury, and optimize rehabilitation paradigms.