The gait lab effect: symmetry restoration strategy after anterior cruciate ligament reconstruction is different in natural environments than the gait laboratory.

Authors

Vu Phan, Evy Meinders, Rozhan Kiani, Andrew L Sprague, James J Irrgang, Jonathan D Hughes, Stephen J Rabuck, Bryson P Lesniak, Volker Musahl, Eni Halilaj

Published in

Journal of biomechanics. Volume 205. Pages 113379. May 22, 2026. Epub May 22, 2026.

Abstract

Inertial measurement units (IMUs) offer a promising pathway to extend functional-recovery assessment after anterior cruciate ligament reconstruction (ACLR) beyond laboratory or in-clinic evaluations. Yet, it remains unclear how joint kinematics change in natural environments over time. In this study, 26 participants wore five sticker-like IMUs on the pelvis, thighs, and shanks for up to seven days, three and nine months after their surgery. They also participated in a laboratory assessment at each timepoint using standard marker- and inertial-based motion capture systems. Knee extension excursion (KEE) was estimated, and inter-limb KEE asymmetry was used as the primary outcome. Median KEE asymmetry decreased significantly from 7.7° at three months to 2.6° at nine months post-surgery, through a modest, 1.0° increase in the reconstructed KEE and a more salient reduction of 4.3° in the contralateral KEE. In the laboratory, however, only a 2.2° decrease in KEE asymmetry was observed, attributed to a 3.3° increase in reconstructed KEE and no significant change in the contralateral KEE. Sensitivity analyses revealed that findings were robust to walking-bout duration and number of days included in the analysis, and all reported group changes in KEE asymmetry exceeded disagreement between IMU- vs. marker-based tracking. Participant compliance to remote monitoring was high, with nearly 95% of the sessions completed. Together, these findings demonstrate that joint-level biomechanics can be captured longitudinally in natural environments after ACLR and that ecologically valid monitoring outside the laboratory can reveal aspects of functional recovery not observed in controlled settings.

PMID:
42398124
Bibliographic data and abstract were imported from PubMed on 04 Jul 2026.

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