Leveraging Limb Loading Metrics to Inform Clinical Decision Making After Anterior Cruciate Ligament Reconstruction

Following anterior cruciate ligament reconstruction (ACLR) many individuals are faced with barriers hindering their ability to successfully return to unrestricted physical activity (RTA). Two primary barriers to individuals following ACLR are physical recovery (i.e., strength and functional performance) and psychological recovery (i.e., kinesiophobia, lack of knee self-efficacy, confidence to RTA, etc.). The point-of-care Lower Extremity Assessment Protocol (LEAP) program utilizes a battery of quadriceps and hamstring strength and symmetry metrics, patient reported outcomes, bilateral bodyweight squatting performance and symmetry metrics to highlight any deficits while tracking patient’s progress throughout rehabilitation. Manuscript I used data from assessments conducted approximately five months post-ACLR to determine the influence of sex on limb loading performance and to determine if a relationship is present between limb loading and patient reported outcomes. We found that females underload their surgical limb more than their male counterparts. Additionally, we found that at five months post-ACLR, individuals have a decreased perception of their ability to complete activities of daily living and lower subjective knee function when their limb loading is asymmetrical. The focus of manuscript II was to assess how limb loading and lower extremity strength (i.e., quadriceps and hamstrings) change between five- and eight-month assessments. We found that there was an increase in loading on the ACLR limb over time as well as improvements in lower extremity strength. However, there was no relationship between the rate of change in limb loading and lower extremity strength. The focus of manuscript III was to determine if limb loading, quadriceps strength, and ACL Return to sport after injury (ACL-RSI) scores at an interim stage of recovery are associated with jump landing performance at a clearance to RTA. We found that unilateral ACLR limb loading and ACL-RSI scores are prognostic of performance during a jump landing. The utilization of limb loading performance throughout early, mid, and late stages of recovery can be used to guide clinical decision making in rehabilitation interventions early to circumvent the potential adoption of poor movement patterns that can increase and individual’s risk of reinjury.