Pain Early After Anterior Cruciate Ligament Reconstruction is Associated With 6-Month Loading Mechanics During Running

Alexa K. Johnson, Nicholas R. Heebner, Emily R. Hunt, Caitlin E.W. Conley, Cale A. Jacobs, Mary L. Ireland, John P. Abt, Christian Lattermann

Research output: Contribution to journalArticlepeer-review


Background: Anterior cruciate ligament reconstruction (ACLR) results in persistent altered knee biomechanics, but contributing factors such as pain or patient function, leading to the altered loading, are unknown. Hypothesis: Individuals with worse self-reported pain after ACLR would have poorer biomechanics during running, and poor loading mechanics would be present in the ACLR limb compared with contralateral and control limbs. Study Design: Cohort pilot study. Level of Evidence: Level 3. Methods: A total of 20 patients after ACLR (age, 18.4 ± 2.7 years; height, 1.7 ± 0.1 m; mass, 84.2 ± 19.4 kg) completed visual analog scale and Knee Injury and Osteoarthritis Outcomes Score (KOOS) at 1 and 6 months postsurgery. At 6 months postsurgery, patients underwent biomechanical testing during running. A total of 20 control individuals also completed running biomechanical analyses. Associations between patient outcomes and biomechanics were conducted, and differences in running biomechanics between groups were analyzed. Results: KOOS pain score 1 month after surgery was associated with peak ACLR knee abduction moment (R2 = 0.35;P = 0.01). At 6-months, KOOS sport score was related to peak abduction moment in the ACLR limb (R2 = 0.23; P = 0.05). For change scores, the improvement in pain scores related to ACLR limb peak knee abduction moment (R2 = 0.55; P = 0.001). The ACLR limb had lower knee excursion, extension moments, and ground-reaction forces compared with the uninvolved and control limb. The uninvolved limb also had higher ground-reaction forces compared with the ACLR limb and control limb. Conclusion: These results suggest that patient-reported outcomes 1 and 6 months after surgery are associated with running mechanics 6 months after ACLR. Further, the underloading present in the ACLR limb and overloading in the uninvolved limb indicates greater need for running rehabilitation after ACLR. Clinical Relevance: Understanding pain and how it may be linked to movement dysfunction is important for improving long-term outcomes.

Original languageEnglish
Pages (from-to)908-916
Number of pages9
JournalSports Health
Issue number6
StatePublished - Nov 1 2023

Bibliographical note

Funding Information:
This research was supported by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences through grant number UL1TR001998 and by the Multidisciplinary Value Program Initiative at the University of Kentucky. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the University.

Publisher Copyright:
© 2022 The Author(s).


  • ACLR
  • biomechanics
  • knee
  • patient-reported outcomes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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