Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction

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Kyle Southall Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA

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Laura Vogtle Department of Occupational Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA

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Harshvardhan Singh Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA

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Matthew P. Ithurburn Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
The American Sports Medicine Institute, Birmingham, AL, USA

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C. Scott Bickel Department of Physical Therapy, Samford University, Birmingham, AL, USA

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Christopher P. Hurt Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA

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Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.

Regardless of professional training, in the clinical setting, the most common means of identifying normalized gait is visual inspection.

Objectively, measuring gait at any timepoint during the rehabilitation of a patient with ACLR is relatively uncommon in clinical practice.

Findings of this study show that there is little standardization in the assessment of gait for individuals following anterior cruciate ligament reconstruction.

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