Individuals with history of primary anterior cruciate ligament reconstruction (ACLR) demonstrate aberrant walking biomechanics such as reduced vertical ground reaction forces (vGRFs) and slow gait speed. These mechanics are related to indicators of poor knee joint health as early as only 6 months post-operative and have also been implicated in the development of knee osteoarthritis (OA). Elevated kinesiophobia is also commonly reported following anterior cruciate ligament (ACL) injury and ACLR, and among individuals with knee OA. As a result, we chose to investigate the association between walking biomechanics, free-living cadence, and kinesiophobia following primary ACLR.In study 1, 65 participants underwent a walking biomechanics assessment to determine: 1) ACLR limb peak vGRF during the first 50% of stance, 2) Between-limb symmetry index for peak vGRF and 3) gait speed. Seventy-two percent of participants (47/65) were characterized as experiencing elevated injury-related fear 6 months following primary ACLR. Despite this prevalence of elevated injury-related fear, kinesiophobia was not significantly associated with ACLR limb first peak vGRF (P=0.634, F=0.230, Î₄R2=0.0021), first peak vGRF limb symmetry (P=0.589, F=0.295, Î₄R2=0.0048), or gait speed (P=0.856, F=0.0333, Î₄R2=.0005) among our sample. Our findings indicate that kinesiophobia may not have a significant influence on walking biomechanics early following surgery; perhaps other interventions such as real-time gait biofeedback may be more effective in addressing aberrant walking early following primary ACLR.℗ In study 2, 48 participants completed a laboratory and free-living assessment of walking characteristics. Laboratory-assessed gait speed was associated with peak 1- minute free-living cadence (r=0.444, P=0.002). ACLR peak vGRF was associated with℗ peak 1-minute free-living cadence (r=0.331, P=0.025). The findings of this study indicate a disconnect between average laboratory gait and average free-living gait. However, our results also suggest that participants who demonstrated faster walking speeds and greater ACLR limb peak vGRFs during their lab assessment also exhibited faster peak minute-level cadences in free-living conditions.℗ In study 3, 30 adolescents who were 6-9 months post primary, unilateral ACLR completed 1 week of free-living step count monitoring to determine average steps taken per day and cadence characteristics. Adolescents who reported elevated injury-related fear demonstrated slower mean light cadences (F=9.518, P=0.005, Îʺp 2=0.268) as compared to adolescents who reported acceptable injury-related fear. Management of elevated kinesiophobia 6-9 months following primary ACLR may provide an avenue to intervene on free-living light cadences among adolescents, with the goal of improving long-term knee joint and general health outcomes.
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