Lower Limb Biomechanics During Single-Leg Landings Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Peta T. Johnston, Jodie A. McClelland, Kate E. Webster

Anterior cruciate ligament reconstruction (ACLR) may not restore lower limb biomechanics during single-limb landings. Our objective was to identify and evaluate differences in lower limb biomechanics during high-demand single-limb landings between the ACLR limb and the contralateral limb and healthy control participants. A systematic review of the literature was conducted using six electronic databases searched until April 2017 for published peer-reviewed studies that investigated lower limb biomechanics on the ACLR limb compared with either the contralateral limb or those of control participants. Meta-analysis with standardized mean differences (SMD) were performed for peak angles and moments (hip, knee and ankle joints) in the sagittal plane during single-limb landing tasks. A total of 35 studies met inclusion criteria. Four different single-leg landing tasks were identified: forward hop (n = 24 studies), landing from a height (n = 9 studies), vertical hop (n = 4 studies), and diagonal leap (n = 1 study). A reduced peak knee flexion angle was found in the ACLR limb compared with the contralateral limb during a forward hop landing task (SMD - 0.39; 95% confidence interval [CI] - 0.59 to - 0.18) and compared with a control group (SMD between - 1.01 and - 0.45) for all three reported single-leg landing tasks: forward hop, landing from a height, and diagonal leap. Similarly, a reduced peak knee internal extensor moment was found in the ACLR limb compared with the contralateral limb for all three reported landing tasks: forward hop, landing from a height, vertical hop (SMD between - 1.43 and - 0.53), and in two of three landing tasks when compared with a control group (SMD between - 1.2 and - 0.52). No significant differences in peak flexion (hip and ankle) angle or peak (hip and ankle) internal extensor moment were found in the ACLR limb compared with both the contralateral limb and a control group. Participants performed single-limb landings on the ACLR limb with reductions in peak sagittal knee kinematics as well as peak joint moments compared with both the contralateral limb and a control group. Stiffer single-leg landings potentially expose the knee joint to higher forces, which may increase risk of injury. Clinical testing after ACLR surgery should explore movement quality as well as performance of functional tasks. Case-control, IV.