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Context Adolescents and adults are treated similarly in rehabilitation and research despite differences in clinical recovery after anterior cruciate ligament reconstruction (ACLR). Aberrant gait is a clinical outcome associated with poor long-term health post-ACLR but has not been compared between adolescents and adults. Objective To compare gait biomechanical waveforms throughout stance between adolescents ( Design Case-control study. Setting Laboratory. Patients or Other Participants Adolescents (n = 13, girls = 77%, age = 16.7 ± 0.6 years, height = 1.7 ± 0.1 m, weight = 22.2 ± 3.7 kg/m2) were identified from a cross-sectional cohort assessing clinical outcomes 6 to 12 months post-ACLR. Young adults (n = 13, women = 77%, age = 22.3 ± 4.0 years, height = 1.7 ± 0.1 m, weight = 22.9 ± 3.3 kg/m2) were matched based on sex, time since surgery (±2 months), and body mass index (±3 kg/m2). Intervention(s) Participants performed 5 gait trials at their habitual speed. Main Outcome Measure(s) Three-dimensional gait biomechanics and forces were collected. Vertical ground reaction force normalized to body weight (xBW), knee-flexion angle (°), knee-abduction moment (xBW × height), and knee-extension moment (BW × height) waveforms were calculated during the stance phase of gait (0%–100%). Habitual walking speed was compared using independent t tests. We used functional waveforms to compare gait biomechanics throughout stance with and without controlling for habitual walking speed by calculating mean differences between groups with 95% CIs. Results Adolescents walked with slower habitual speeds compared with adults (adolescents = 1.1 ± 0.1 m/s, adults = 1.3 ± 0.1 m/s, P < .001). When gait speed was not controlled, adolescents walked with less vertical ground reaction force (9%–15% of stance) and knee-abduction moment (12%–25% of stance) during early stance and less knee-extension moment during late stance (80%–99% of stance). Regardless of their habitual walking speed, adolescents walked with greater knee-flexion angle throughout most stances (0%–21% and 29%–100% of stance). Conclusions Adolescents and adults demonstrated different gait patterns post-ACLR, suggesting that age may play a role in altered gait biomechanics.

CONTEXT Patient reported outcomes (PROs) are utilized to track recovery and inform clinical decision-making following anterior cruciate ligament reconstruction (ACLR). It remains unclear if sex influences the trajectory of improvements in PROs over time post-ACLR. OBJECTIVE 1) to examine the effect of sex on the association between months post-ACLR and Knee Osteoarthritis Outcome Scores (KOOS) Quality of Life (QOL) scores in individuals with ACLR; and 2) to assess sex differences in KOOS QOL at selected timepoints post-ACLR. DESIGN Cross-sectional SETTING Laboratory PATIENTS OR OTHER PARTICIPANTS 133 females (20±3 yrs) and 85 males (22±4 yrs) within 6–60 months of primary, unilateral ACLR. MAIN OUTCOME MEASURES KOOS QOL was completed at a single follow-up timepoint post-ACLR. A multivariate, linear regression model was utilized to assess the interaction of sex on the association between months post-ACLR and KOOS QOL. Sex-specific, linear regression models were then used to predict KOOS QOL estimated marginal means (EMM) at each clinical timepoint (6,12, 24, 36, 48 and 60 months post-ACLR) and compared between sex. RESULTS In the primary model (R2=0.16, p CONCLUSION Males appear to exhibit PROs improvement post-ACLR at increasing months post-ACLR, while females do not demonstrate the same magnitude of linear increase in KOOS QOL. Females may require extended intervention to improve clinical outcomes post-ACLR and address a plateau in QOL.

Objective A complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR. Design Twenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients ( r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase. Results Greater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC ( r ranging between 0.43 and 0.46). Conclusions Biomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.