Document Type : Research Paper


1 PhD student in Corrective exercises and Sport Injuries, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran

2 Professor, Department of Sport Injury and Corrective Exercise, School of Physical Education and Sports Sciences, University of Isfahan, Isfahan, Iran

3 Ph.D. of Sports Biomechanics, Assistant Professor in, Faculty of Sport Sciences, University of Isfahan, Iran.


Gait mechanics alternation remain after anterior cruciate ligament reconstruction (ACLR). Evaluating the center of pressure (COP) trajectory is one of the variables that reflects whole mechanics of walking and running. The aim of this study was to compare the COP trajectory in people with a history of ACLR surgery. 48 male basketball players (24 with history of surgery and 24 healthy) participated in this study. The barefoot walking and running COP of both legs of the subjects was recorded by the footscan device in two medio-lateral and antero-posterior directions and was calculated in 4 subphases of the stance phase. The results showed that COP trajectory in walking and running was more medially directed in the forefoot push-off subphase in the ACLR group. Also, in the ACLR group, COP of the injured leg in the forefoot push-off subphase during walking and running was more medially directed than the healthy leg. Regarding the results of the present study, it can be concluded that the COP trajectory is different from that of healthy subjects after ACLR. This difference in COP trajectory can result in altered knee loading and increase risk of knee osteoarthritis.


Main Subjects

  1. Devita P, Hortobagyi T, Barrier J, Torry M, Glover KL, Speroni DL, et al. Gait adaptations before and after anterior cruciate ligament reconstruction surgery. Medicine and science in sports and exercise. 1997;29(7):853-9.
  2. Ferber R, Osternig LR, Woollacott MH, Wasielewski NJ, Lee J-H. Gait mechanics in chronic ACL deficiency and subsequent repair. Clinical biomechanics. 2002;17(4):274-85.
  3. Sharifi A, Esmaeili H. Assessment of proprioception and knee muscles strength after rehabilitation of anterior cruciate ligament in comparison with healthy matches. Studies in Sport Medicine. 2020;11(26):49-66.(Persian)
  4. Gardinier ES, Manal K, Buchanan TS, Snyder‐Mackler L. Altered loading in the injured knee after ACL rupture. Journal of Orthopaedic Research. 2013;31(3):458-64.
  5. Mather III RC, Koenig L, Kocher MS, Dall TM, Gallo P, Scott DJ, et al. Societal and economic impact of anterior cruciate ligament tears. The Journal of bone and joint surgery American volume. 2013;95(19):1751.
  6. Williams JR, Neal K, Alfayyadh A, Lennon K, Capin JJ, Khandha A, et al. Knee cartilage T2 relaxation times 3 months after ACL reconstruction are associated with knee gait variables linked to knee osteoarthritis. Journal of Orthopaedic Research®. 2022;40(1):252-9.
  7. Gokeler A, Benjaminse A, Van Eck C, Webster K, Schot L, Otten E. Return of normal gait as an outcome measurement in acl reconstructed patients. A systematic review. International journal of sports physical therapy. 2013;8(4):441.
  8. Davis-Wilson HC, Pfeiffer SJ, Johnston CD, Seeley MK, Harkey MS, Blackburn JT, et al. Bilateral gait six and twelve months post-ACL reconstruction compared to controls. Medicine and science in sports and exercise. 2020;52(4):785.
  9. Butler R, Minick K, Ferber R, Underwood F. Gait mechanics after ACL reconstruction: implications for the early onset of knee osteoarthritis. British journal of sports medicine. 2009;43(5):366-70.
  10. Whittle MW. Gait analysis: an introduction: Butterworth-Heinemann; 2014.
  11. Chesnin KJ, Selby-Silverstein L, Besser MP. Comparison of an in-shoe pressure measurement device to a force plate: concurrent validity of center of pressure measurements. Gait & posture. 2000;12(2):128-33.
  12. Huang H, Qiu J, Liu T, Yu Y, Guo Q, Luo D, et al. Similarity of center of pressure progression during walking and jogging of anterior cruciate ligament deficient patients. PLoS One. 2017;12(1):e0169421.
  13. Mohammadi-Rad S, Bandpei MAM, Salavati M, Talebian S, Keyhani S, Shanbehzadeh S. Reliability of Center of Pressure measures of Postural Stability in Anterior Cruciate Ligament Reconstructed Athletes: Effect of Vibration and Cognitive Load. Archives of Bone and Joint Surgery. 2022;10(2):171.
  14. Willems TM, De Clercq D, Delbaere K, Vanderstraeten G, De Cock A, Witvrouw E. A prospective study of gait related risk factors for exercise-related lower leg pain. Gait & posture. 2006;23(1):91-8.
  15. Jenkyn TR, Erhart JC, Andriacchi TP. An analysis of the mechanisms for reducing the knee adduction moment during walking using a variable stiffness shoe in subjects with knee osteoarthritis. Journal of biomechanics. 2011;44(7):1271-6.
  16. De Wit B, De Clercq D. Timing of lower extremity motions during barefoot and shod running at three velocities. Journal of Applied Biomechanics. 2000;16(2):169-79.
  17. McCaw ST, DeVita P. Errors in alignment of center of pressure and foot coordinates affect predicted lower extremity torques. Journal of biomechanics. 1995;28(8):985-8.
  18. Huang H, Keijsers N, Horemans H, Guo Q, Yu Y, Stam H, et al. Anterior cruciate ligament rupture is associated with abnormal and asymmetrical lower limb loading during walking. Journal of Science and Medicine in Sport. 2017;20(5):432-7.
  19. De Cock A, De Clercq D, Willems T, Witvrouw E. Temporal characteristics of foot roll-over during barefoot jogging: reference data for young adults. Gait & posture. 2005;21(4):432-9.
  20. Anbarian M, Esmaeili H. Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types. Gait & posture. 2016; 48:52-6.
  21. Willems TM, De Ridder R, Roosen P. The effect of a long-distance run on plantar pressure distribution during running. Gait & posture. 2012;35(3):405-9.
  22. Hall M, Perraton LG, Stevermer CA, Gillette JC. Alterations in medial-lateral postural control after anterior cruciate ligament reconstruction during stair use. Gait & Posture. 2020; 77:283-7.
  23. Culvenor AG, Alexander BC, Clark RA, Collins NJ, Ageberg E, Morris HG, et al. Dynamic single-leg postural control is impaired bilaterally following anterior cruciate ligament reconstruction: implications for reinjury risk. journal of orthopaedic & sports physical therapy. 2016;46(5):357-64.
  24. Chiu M-C, Wu H-C, Chang L-Y, Wu M-H. Center of pressure progression characteristics under the plantar region for elderly adults. Gait & posture. 2013;37(3):408-12.
  25. Lyle MA, Jensen JC, Hunnicutt JL, Brown JJ, Chambliss CP, Newsome MA, et al. Associations of Strength and Spatiotemporal Gait Variables With Knee Loading During Gait After Anterior Cruciate Ligament Reconstruction. Journal of Athletic Training. 2022;57(2):158-64.
  26. Asaeda M, Deie M, Kono Y, Mikami Y, Kimura H, Adachi N. The relationship between knee muscle strength and knee biomechanics during running at 6 and 12 months after anterior cruciate ligament reconstruction. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology. 2019; 16:14-8.
  27. Stergiou N, Ristanis S, Moraiti C, Georgoulis AD. Tibial rotation in anterior cruciate ligament (ACL)-deficient and ACL-reconstructed knees. Sports medicine. 2007;37(7):601-13.
  28. Matsusaka N. Control of the medial-lateral balance in walking. Acta Orthopaedica Scandinavica. 1986;57(6):555-9.
  29. Hemmerich A, van der Merwe W, Batterham M, Vaughan CL. Knee rotational laxity in a randomized comparison of single-versus double-bundle anterior cruciate ligament reconstruction. The American journal of sports medicine. 2011;39(1):48-56.
  30. Knoll Z, Kocsis L, Kiss RM. Gait patterns before and after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2004; 12:7-14.