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Purpose <p>To restore knee stability after an anterior cruciate ligament (ACL) rupture, especially among athletes, ACL reconstruction (ACLR) is frequently performed. Despite favorable surgical outcomes, many individuals exhibit persistent biomechanical deficits that can alter running mechanics and increase the risk of secondary injuries and long-term complications, such as knee osteoarthritis. A detailed understanding of these biomechanical alterations is crucial for guiding effective rehabilitation strategies.</p> Methods <p>A systematic review and meta-analysis were conducted to compare kinematic and kinetic variables during running in individuals post-ACLR versus healthy controls.&#xa0;Following PRISMA guidelines, we conducted a comprehensive search across five databases (PubMed, Scopus, EMBASE, Cochrane CENTRAL, and PEDro) from their inception to June 2025.&#xa0;Studies were selected using the PECOS framework, with a focus on lower-limb biomechanics during the stance phase of running. Two reviewers independently performed data extraction.&#xa0;The methodological quality of included studies was appraised using a modified Downs and Black checklist.&#xa0;Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model to determine pooled effect sizes for key biomechanical outcomes.</p> Results <p>Fifteen cross-sectional studies comprising 1023 ACLR patients and 847 healthy controls met the inclusion criteria. Meta-analysis revealed significant reductions in peak knee flexion angle (SMD =  − 0.80, 95% CI − 1.47 to − 0.13; <i>P</i> = 0.02), peak knee extension angle (SMD =  − 0.97, 95% CI − 1.40 to − 0.53; <i>P</i> &lt; 0.001), and knee extension moment (SMD =  − 1.41, 95% CI − 2.67 to − 0.14; <i>P</i> = 0.03) in the ACLR group. Increased activation of the biceps femoris was observed (SMD = 0.99, 95% CI 0.22 to 1.76; <i>P</i> = 0.01). No significant differences were found in vertical ground-reaction forces (SMD = 0.06, 95% CI − 0.49 to 0.61; <i>P</i> = 0.76) or loading rate (SMD = 0.04, 95% CI − 0.65 to 0.74; <i>P</i> = 0.90).</p> Conclusions <p>Individuals following ACLR demonstrate reduced sagittal-plane knee motion and extensor moments during running, accompanied by increased hamstring activation, compared with healthy controls. These persistent biomechanical alterations suggest incomplete restoration of dynamic knee function and highlight the need for rehabilitation strategies targeting quadriceps performance and neuromuscular control to reduce potential reinjury risk.</p>

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Effects of anterior cruciate ligament reconstruction on running biomechanics: a systematic review with meta-analysis of cross-sectional studies

  • 期刊论文

  • 发表日期：

    2026年3月8日

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  • Ebrahim Piri,
  • AmirAli Jafarnezhadgero,
  • Valdeci Carlos Dionisio

摘要

Purpose

To restore knee stability after an anterior cruciate ligament (ACL) rupture, especially among athletes, ACL reconstruction (ACLR) is frequently performed. Despite favorable surgical outcomes, many individuals exhibit persistent biomechanical deficits that can alter running mechanics and increase the risk of secondary injuries and long-term complications, such as knee osteoarthritis. A detailed understanding of these biomechanical alterations is crucial for guiding effective rehabilitation strategies.

Methods

A systematic review and meta-analysis were conducted to compare kinematic and kinetic variables during running in individuals post-ACLR versus healthy controls. Following PRISMA guidelines, we conducted a comprehensive search across five databases (PubMed, Scopus, EMBASE, Cochrane CENTRAL, and PEDro) from their inception to June 2025. Studies were selected using the PECOS framework, with a focus on lower-limb biomechanics during the stance phase of running. Two reviewers independently performed data extraction. The methodological quality of included studies was appraised using a modified Downs and Black checklist. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model to determine pooled effect sizes for key biomechanical outcomes.

Results

Fifteen cross-sectional studies comprising 1023 ACLR patients and 847 healthy controls met the inclusion criteria. Meta-analysis revealed significant reductions in peak knee flexion angle (SMD =  − 0.80, 95% CI − 1.47 to − 0.13; P = 0.02), peak knee extension angle (SMD =  − 0.97, 95% CI − 1.40 to − 0.53; P < 0.001), and knee extension moment (SMD =  − 1.41, 95% CI − 2.67 to − 0.14; P = 0.03) in the ACLR group. Increased activation of the biceps femoris was observed (SMD = 0.99, 95% CI 0.22 to 1.76; P = 0.01). No significant differences were found in vertical ground-reaction forces (SMD = 0.06, 95% CI − 0.49 to 0.61; P = 0.76) or loading rate (SMD = 0.04, 95% CI − 0.65 to 0.74; P = 0.90).

Conclusions

Individuals following ACLR demonstrate reduced sagittal-plane knee motion and extensor moments during running, accompanied by increased hamstring activation, compared with healthy controls. These persistent biomechanical alterations suggest incomplete restoration of dynamic knee function and highlight the need for rehabilitation strategies targeting quadriceps performance and neuromuscular control to reduce potential reinjury risk.