A D1-level publication by research professor Tibor Hortobágyi is published

A review article related to anterior cruciate ligament (ACL) reconstruction written by research professor Tibor Hortobágyi and his colleagues has appeared in the journal Sports Medicine Open.

A review article titled Time-Dependent Alterations in Walking Biomechanics After Anterior Cruciate Ligament Reconstruction Compared with Healthy Individuals: A Systematic Review with Meta-analysis written by Tibor Hortobágyi, research professor of the Department of Kinesiology, and his co-authors was recently published in Sports Medicine Open.

Anterior cruciate ligament tear is a serious knee injury. Rehabilitation aims to restore knee joint stability and gait function. Even though intensive and complex rehabilitation of neuromuscular function to pre-injury levels can last up to a year, many athletes never return to their previous competitive level and ~ 25% of returners suffer a re-injury.

Background information of the review revealed many inconsistencies in gait biomechanics after ACL rehabilitation (ACLR). While many studies failed to observe between-leg asymmetries in knee function such as range of motion, proprioception, muscle strength, and neuromechanical control, an equal number of studies did report such asymmetries. Perhaps such imbalances are long-term and are related to the high risks for re-injury and a strongly increased risk in up to 80% of ACLR patients to develop knee osteoarthritis 10–15 years post-surgery. With such a background, the international team set out to compare lower extremity joint biomechanics recorded during walking in ACLR and non-ACLR individuals. The team also determined the time course of recovery of gait biomechanics following ACLR.

The statistical analyses included 1,024 ACLR and 701 healthy controls of both sexes age 17–55 from 31 cross-sectional studies. ACLR individuals walked with a more erect gait even one year after the end of rehabilitation, which is known to increase the tension in ACL, suggesting a kinematically unfavourable gait. Up until six months post-surgery, ACLR patients vs. healthy controls had also lower peak knee adduction angles, again suggesting a less dynamic knee function. Knee kinetics was also affected long-term, as peak knee extension and flexion joint moments both were lower in ACLR group compared to healthy controls.

The kinetics data thus suggest incompletely restored knee effort even though rehabilitation was considered successful and complete. Such kinetics require ACLR to execute such a simple task as walking with a greater relative effort. We now need to see how and if it is possible to restore gait function to pre-injury levels in ACLR individuals and if such restoration does indeed reduce risks for re-injury and knee osteoarthrosis. There are currently insufficient data to determine the effects of ACLR on running biomechanics.

Reference: Esmaeili A, Jafarnezhadgero A, Sajedi H, Aydin E, Hortobágyi, Granacher U. Time-dependent alterations in walking biomechanics after anterior cruciate ligament reconstruction compared with healthy individuals: A systematic review with meta-analysis. Sports Medicine Open, In press, April 2026 (open access).

Tags: publication,research,Tibor Hortobágyi

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