전방십자인대 재건 수술 후 보행 운동학 이상이 수술 후 1년 이상 지나도 정상 수준으로 회복되지 않는다는 메타분석 결과가 나왔다.
국제학술지 《Sports Medicine Open》 2026년호에 발표된 이 연구는 17~55세 남녀를 대상으로 한 31개 단면 연구를 체계적으로 분석했다. 분석 결과 ACL 재건 환자는 정상 대조군에 비해 보행 시 무릎 최대 굴곡각이 유의하게 감소했다.
이 무릎 굴곡각 감소는 수술 후 12개월이 지난 후에도 지속됐다. 수술 후 6개월 이내에는 무릎 내전각감소도 나타났다. 수술 후 경과 시간과 무관하게 무릎 굴곡 모멘트도 정상군보다 유의하게 낮았다.
무릎 굴곡각과 굴곡 모멘트 감소는 무릎 관절의 하중 흡수 능력 저하를 의미한다. 이는 장기적으로 연골에 비정상적인 압력을 가해 퇴행성 관절염 발병 위험을 높일 수 있다. ACL 손상 환자에서 수술 후 수년 내 OA 발병률이 높다는 기존 연구와도 일치하는 결과다.
연구진은 "현재 ACL 재활 프로토콜이 스포츠 복귀 기준에는 초점을 맞추고 있지만, 정상적인 보행 역학 회복을 목표로 하는 구체적인 개입이 부족하다"면서 재활 프로그램 강화를 촉구했다.
ACL 재건 후 재활 과정에서 보행 분석을 통한 운동학 모니터링과 함께, 무릎 굴곡 기능 회복에 초점을 맞춘 훈련이 병행돼야 할 것으로 보인다.
※ 출처: Sports Medicine Open, 2026. PMID: 41942807
Patients who undergo anterior cruciate ligament (ACL) reconstruction continue to show abnormal walking biomechanics compared to healthy individuals even more than one year after surgery, according to a systematic review and meta-analysis published in Sports Medicine Open in 2026.
Researchers pooled data from 31 cross-sectional studies involving men and women aged 17 to 55 years, comparing gait biomechanics between ACL reconstruction patients and healthy controls at various time points following surgery.
The analysis identified consistent and statistically significant deficits in two key gait parameters. First, ACL reconstruction patients showed reduced peak knee flexion angle during walking compared to healthy controls (standardized mean difference SMD=−0.50, p=0.0004). This reduction was not confined to the early post-operative period — it persisted beyond 12 months after surgery, indicating that the deficit endures well into what many clinicians consider the recovered phase.
Second, knee flexion moment during walking was significantly lower in ACL reconstruction patients at all time points examined, regardless of how much time had passed since surgery (SMD=−0.57, p=0.0005). A reduced knee adduction angle was additionally observed in the first six months post-operatively, though this finding appeared more time-dependent.
Reduced knee flexion angle and flexion moment during walking are biomechanically meaningful deficits. The knee's ability to flex and absorb load during gait is central to distributing forces appropriately across joint structures. When this capacity is diminished, atypical loading patterns can develop, placing excessive or unevenly distributed pressure on articular cartilage. Over time, this may accelerate cartilage degradation and contribute to the elevated rates of osteoarthritis (OA) observed in ACL-injured populations in the years and decades after injury.
The persistence of these gait abnormalities beyond 12 months challenges the assumption that patients who meet standard return-to-sport criteria — which typically focus on strength symmetry, hop tests, and psychological readiness — have also restored normal locomotor mechanics. The data suggest a disconnect between functional milestones and the recovery of normal walking kinematics.
The authors called for rehabilitation programs to explicitly target restoration of normal gait biomechanics, not just sport-specific performance markers. Incorporating gait analysis into post-operative monitoring, and designing exercises that specifically rehabilitate knee flexion during walking, may help close the gap between functional recovery and true biomechanical normalization.
Source: Sports Medicine Open, 2026. PMID: 41942807
