Authors (including presenting author) :
Dicky Hui (1),Dorothy Fong(1), Andy Yu(1), Joseph Man(1), Eric Fung(1)
Affiliation :
Department of Physiotherapy,Caritas Medical Centre
Introduction :
The traditional outcome measurements of rehabilitation program after ACL reconstruction surgery are range of motion and muscle power of the knee, functional outcomes in quantitative aspect such as walking stability and dynamic balance especially in subacute phase are lacking. To fill the blank, Computer-aided Gait Analyzer (CGA) was introduced.
Objectives :
To develop and provide data of walking symmetry and dynamic balance in gait parameters as quantitative functional outcomes to monitor the rehabilitation progress in subacute phase
Methodology :
A retrospective study of ACL reconstruction surgery was reviewed in 2020. 12 patients with mean age 26.8 years old, received ACL rehabilitation program in Out-Patient Department of Physiotherapy were recruited. All patients performed adaptation-familiarization trial to determine individual comfort walking speed before measurement. Then patients were instructed to walk barefoot on the CGA for one minute at their comfort speed. Gait parameters such as walking speed, step length, weight bearing force of lower limbs, double stance phase, absolute lateral symmetry and walking variability were collected for analysis. Besides, gait analysis was performed at post-op 1 month, 2 months and 3 months. 16 normal subjects with mean age 26.6 years old were recruited as reference group. Furthermore, patient group was compared with reference group.
Result & Outcome :
The initial mean walking speed of the patient was 1.8 km/hr at post-op 1 month, and was improved to 3.1 km/hr and to 4.2 km/hr at post-op 2 months and 3 months respectively. But the walking speed of patient at post-op 3 months was still significantly slower than the normal subjects (4.6 km/hr; P= 0.036). In terms of gait symmetry, mean difference of step length and weight bearing between the operated leg and the non-operated were continuously improved after physiotherapy training. Since post-op 2 months, no significant difference in step length (p>0.05) was found and there was no significant difference in weight bearing (p=0.15) at post-op 3 months when compared to normal individuals. Regarding dynamic balance of the patients, double stance phase was improved from 38.4% through 28.9% to 25.7%; absolute lateral symmetry was improved from 15.7mm through 4.5mm to 3.2mm as well as walking variability was improved from 12.9mm through 4.6mm to 3.4mm at post-op 2 and 3 months respectively. However, they were still not comparable to normal subjects (double stance phase: 23.8%; lateral symmetry: 1.3mm and walking variability: 2.5mm) even at post-op 3 months (p=0.038); (P=0.023); (p=0.006). In conclusion, the gait symmetry of patients underwent ACL reconstruction returned to normal level at post-op 2-3 months but walking speed and dynamic balance were still below normal level even at post-op 3 months. With reference to normal data, walking speed, gait symmetry and dynamic balance could be used as quantitative functional outcome for monitoring the progress of young patients with ACL reconstruction in subacute phase (Up to post-op 3 months).
