Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis

BACKGROUND

Altered joint motion that occurs in people with an anterior cruciate ligament deficient knee is proposed to play a role in the initiation of knee osteoarthritis, however, the exact mechanism is poorly understood. Although several studies have investigated gait deviations in individuals with chronic anterior cruciate ligament deficient knee in the frontal and transverse planes, no systematic review has summarized the kinematic and kinetic deviations in these two planes.

METHODS

We searched five electronic databases from inception to 14th October 2013, with key words related to anterior cruciate ligament, biomechanics and gait, and limited to human studies only. Two independent reviewers assessed eligibility based on predetermined inclusion/exclusion criteria and methodological quality was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology statement checklist.

FINDINGS

We identified 16 studies, totaling 183 subjects with anterior cruciate ligament deficient knee and 211 healthy subjects. Due to the variability in reported outcomes, we could only perform meta-analysis for 13 sagittal plane outcomes. The only significant finding from our meta-analysis showed that individuals with anterior cruciate ligament deficient knee demonstrated a significantly greater external hip flexor angular impulse compared to control (P=0.03).

INTERPRETATION

No consensus about what constitutes a typical walking pattern in individuals with anterior cruciate ligament deficient knee can be made, nor can conclusions be derived to explain if gait deviations in the frontal and transverse plane contributed to the development of the knee osteoarthritis among this population.

Student learning preferences reflect curricular change

This study measured the learning preference profile development and readiness for self-directed learning over time of two undergraduate student cohorts experiencing different curricular presentations of essentially the same syllabus. The results from three measurement points are reported following each cohort through their first half of the BSc (Honours) Physiotherapy Course, Cardiff. At intake both cohorts preferred a concrete, fact-based learning environment, which was teacher structured. Over time, the cohorts responded significantly differently to their curricula in respect of the student-structured learning preference (LP) variable (p < 0.05), and displayed trends (p < 0.1) towards response difference for the concrete, interpersonal and individual LP variables. Cohort differences are discussed in terms of the planned curriculum changes made during the intervening revalidation exercise. It is suggested that curricula mould students' learning profile development. The impact of this statement on future curriculum development is discussed and educational research-in-action promoted.