Immediate Biochemical Changes After Gait Biofeedback in Individuals With Anterior Cruciate Ligament Reconstruction

Context: Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage metabolism. Objective: To determine if acutely manipulating peak vertical ground reaction force (vGRF) during gait influences acute changes in serum cartilage oligomeric matrix protein concentration (sCOMP) among individuals with ACLR. Design: Crossover study. Patients or Other Participants: Thirty individuals with unilateral ACLR participated (70% female, age = 20.43 +/- 2.91 years old, body mass index = 24.42 +/- 4.25, months post-ACLR = 47.83 +/- 26.97). Additionally, we identified a subgroup of participants who demonstrated an increase in sCOMP after the control or natural loading condition (sCOMP(CHANGE) > 0 ng/mL, n = 22, 70% female, age = 20.32 +/- 3.00 years old, body mass index = 24.73 +/- 4.33, months post-ACLR = 47.27 +/- 29.32). Main Outcome Measure(s): Serum was collected both prior to and immediately after each condition to determine sCOMPchange. Intervention(s): All participants attended 4 sessions that involved 20 minutes of walking on a force-measuring treadmill consisting of a control condition (natural loading) followed by random ordering of 3 loading conditions with real-time biofeedback: (1) symmetric vGRF between limbs, (2) a 5% increase in vGRF (high loading) and (3) a 5% decrease in vGRF (low loading). A general linear mixed model was used to determine differences in sCOMPCHANGE between altered loading conditions and the control group in the entire cohort and the subgroup. Results: The sCOMPCHANGE was not different across loading conditions for the entire cohort (F-3,F-29 = 1.34, P=.282). Within the subgroup, sCOMPCHANGE was less during high loading (1.95 +/- 24.22 ng/mL, t(21) = -3.53, P=.005) and symmetric loading (9.93 +/- 21.45 ng/mL, t(21) = -2.86, P=.025) compared with the control condition (25.79 +/- 21.40 ng/mL). Conclusions: Increasing peak vGRF during gait decreased sCOMP in individuals with ACLR who naturally demonstrated an increase in sCOMP after 20 minutes of walking.