Biomechanical asymmetries differ between autograft types during unplanned change of direction after ACL reconstruction

Joshua J. Miles, Polly M. McGuigan, Enda King, Katherine A.J. Daniels

Research output: Contribution to journalArticlepeer-review

3 Citations (SciVal)


Nine months after anterior cruciate ligament (ACL) reconstruction, athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft demonstrate higher loading asymmetries during vertical jumping than those with a hamstring tendon (HT) autograft. These asymmetries may transfer into sporting movements with a greater ACL injury risk. The aim of this study was to compare between-limb asymmetries in knee mechanics and task performance during an unplanned 90° change-of-direction (CoD) task in male field sport athletes reconstructed with BPTB or HT autografts. Seventy-eight male multidirectional field sport athletes with either a BPTB (n = 39) or HT (n = 39) autograft completed maximal unplanned CoD trials in a three-dimensional motion capture laboratory at approximately 9 months post-surgery. A mixed-model 2x2 ANOVA (autograft type x limb) was used to compare variables related to ACL injury risk (e.g., internal knee moments) and performance (e.g., completion time) between autografts and limbs. Statistical parametric mapping was used for a waveform comparison throughout stance, supplemented with a discrete point analyses of peak knee moments and performance variables. Interaction effects were found at the knee joint, with BPTB demonstrating greater asymmetries than HT in knee extension moment (p < 0.001); resultant ground reaction force (p < 0.001); peak knee external rotation moment (p = 0.04); and knee adduction (p = 0.05), medial rotation (p < 0.001), and flexion (p < 0.001) angles. No differences were found between autografts for any performance variable. BPTB demonstrated greater lower-limb biomechanical asymmetries than HT during CoD, which may influence knee loading and longer-term outcomes and should thus be targeted during rehabilitation prior to return to play.

Original languageEnglish
Pages (from-to)1236-1248
Number of pages13
JournalScandinavian Journal of Medicine and Science in Sports
Issue number8
Early online date14 Apr 2022
Publication statusPublished - 31 Aug 2022


  • anterior cruciate ligament
  • asymmetry
  • bone-patellar tendon-bone autograft
  • hamstring autograft
  • rehabilitation
  • statistical parametric mapping

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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