Gender Influences Gait Asymmetry After Bicruciate-Retaining TKA

It is well established that knee kinematics during gait differ between men and women. Gender differences in the functioning of the anterior cruciate ligament (ACL) is thought to be a contributing factor.

Now, Young-Min Kwon, MD, PhD, program director of the Adult Reconstructive Surgery Fellowship Program and director of the Bioengineering Laboratory at Massachusetts General Hospital, and colleagues have also observed gender differences in gait kinematics after bicruciate-retaining total knee arthroplasty (TKA), which preserves ACL. Their report appears in the Journal of Knee Surgery.

Study Design

The researchers studied patients who had undergone unilateral bicruciate-retaining TKA with ACL preservation without surgical complications. There were no significant differences between the gender groups in age (average 66 years in both groups), body mass index, laterality of the surgery or length of follow-up (average of one year in both groups). Based on computed tomography scans of the patients' lower legs, the researchers created three-dimensional models of both knees. The patients then walked on a treadmill under surveillance by a dual fluoroscopic imaging system.

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The fluoroscopic images and the 3D knee models were imported into a computer system for the determination of kinematic values during gait. The researchers compared values between operative and non-operative knees as well as between men and women.

Knee Rotation

Operative Knee vs. Non-operative Knee

• Women: Significant differences between the knees in varus/valgus rotation and internal/external rotation; no difference in flexion/extension rotation

• Men: No significant differences between the knees in any of the three rotational parameters

Men vs. Women

• For both men and women, and in every parameter, there were significant rotational asymmetries between the knees during at least some portion of the gait cycle

• There were no significant differences in asymmetries between the two gender groups

Femoral Translation

Operative Knee vs. Non-operative Knee

• Women: Significant differences between the knees in medial/lateral (M/L) and anterior/posterior (A/P) translation; no difference in proximal/distal translation

• Men: Same pattern as for the women

Men vs. Women

• For both men and women, in the M/L and A/P motions, there were significant asymmetries between the knees during at least some portion of the gait cycle

• However, women showed sustained A/P translation asymmetry between the knees, particularly early in the stance phase (10%–50% of the gait cycle), which was significantly different from the A/P translational asymmetry found in the men

• Women showed more femoral posterior translation in the operative knee than in the non-operative knee during most of the stance phases, whereas men exhibited less femoral translation in the operative knee

The study was the first to demonstrate that gender influences in vivo knee kinematics in TKA patients with preserved ACL during gait. The researchers report that their findings are likely to be explained by gender differences in the function of the preserved ACL in bicruciate-retaining TKA. They note that female athletes suffer a disproportionately higher rate of ACL rupture during contact and pivot sports, which has been attributed to gender differences in the diameter and strength of the ACL, Q-angle and valgus motion during flexion, hormonal influences and neuromuscular control.

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