Effect of muscle compensation on knee instability during ACL-Deficient gait

Purpose: The purpose of this investigation was to determine whether an isolated change in either quadriceps or hamstrings muscle force (quadriceps avoidance and hamstrings facilitation, respectively) is sufficient to stabilize the ACL-deficient (ACLd) knee during gait. Methods: A three-dimensional model of the lower limb was used to calculate anterior tibial translation in the intact and ACLd knee during gait. The model was then used to predict the amount of quadriceps and hamstrings force needed to restore anterior tibial translation (ATT) in the ACLd knee to an intact or maximum allowable level. Results: It was possible to reduce ATT in the ACLd knee to the level calculated for the intact knee by increasing the magnitude of hamstrings force (a hamstrings facilitation pattern). Although this strategy decreased the knee extensor moment calculated for walking, the effect was much less than that obtained when quadriceps force was reduced. Reducing quadriceps force to restore normal ATT resulted in complete elimination of the knee extensor moment (a quadriceps avoidance pattern); however, this strategy was insufficient to restore ATT to the level calculated for the intact knee over portions of the gait cycle. Conclusion: The model simulations showed that increased hamstrings force was sufficient to stabilize the ACLd knee during gait. Reduced quadriceps force was insufficient to restore normal ATT for portions of the gait cycle.