Dynamic Assessment in Patients Following Bone-Patellar Tendon-Bone Autograft Anterior Cruciate Ligament Reconstruction§

Roger Lyon*, 1, Xue-Cheng Liu 1, John Hung 1, Thomas W Kernozek 2
1 Department of Orthopaedic Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, 9000 W. Wisconsin Ave., P.O. Box 1997, Suite C360, Milwaukee, WI 53201, USA
2 Department of Health Profession, University of Wisconsin-La Cross, La-Cross, WI 54601, USA

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© Lyon et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Children’s Hospital of Wisconsin, 9000 W. Wisconsin Ave., PO. Box 1997, Suite C360, Milwaukee, WI 53201, USA; Tel: 414.337.7325; Fax: 414.337.7337; E-mail:



The knee’s passive movement is insufficient to determine function in patients following ACL reconstruction.


We hypothesize that there are kinematic differences in the lower extremities (LE) during stair climbing and ground level walking following ACL surgery between the intact and reconstructed sides.

Study Design:

This was a retrospective cohort study. Eleven patients with an average age of 15.3 years at the time of their ACL reconstructive surgery (BPTB autograft) participated in the study.


Patients were followed for at least 2 years post surgery. The subjects underwent a non-weight bearing ability test to reproduce predetermined knee joint positions. Their LE’s velocity and joint kinematics were then measured during level ground walking and on a set of custom designed stairs as they ascended and descended.


During level ground walking the maximum internal rotation at the ankle during the swing phase on the reconstructed side increased significantly from 2.3º to 19.9 º compared to the unreconstructed limb (P=0.04). The leading reconstructed knee during stair ascent exhibited less knee flexion as compared to the unreconstructed knee for each step (1st step: 74.2º vs 81.5º; 2nd step:93.6º vs 97.6º; 3rd step: 48º vs 53.5º; 4th step: 72.5º vs 78.1º; p<0.05).


A two-year follow-up study in adolescents who had a bone-patellar tendon-bone autograft demonstrated that they had normal knee proprioception and 3D joint rotations of the LE, while showing an alteration of the ankle and knee kinematics during walking or ascending stairs.

Keywords: ACL, gait analysis, proprioception, stair.