Research Article| Volume 104, 105941, April 2023

Using load sensing insoles to identify knee kinetic asymmetries during landing in patients with an Anterior Cruciate Ligament reconstruction


      • Insole impulse and peak knee extension moment limb symmetry have correlation.
      • Force sensing insoles agree with knee extension moment; symmetric or asymmetric.
      • Insoles could screen for kinetic asymmetries in anterior cruciate ligament repairs.



      Knee extension moment asymmetry is a known second anterior cruciate ligament injury risk factor in patients who have had an anterior cruciate ligament reconstruction. Traditionally, assessing asymmetries requires motion capture and force platforms which are expensive and occupy a large space. Wireless force sensing insoles could be a feasible surrogate.


      Twenty-nine patients following anterior cruciate ligament reconstruction performed ten bilateral stop jumps while insole forces, ground reaction forces, and lower extremity kinematics were collected. Peak knee extension moment symmetry was computed using the kinematic and kinetic data, and peak impact force symmetry and impulse symmetry were computed using both the insole force data and vertical ground reaction force data. The relationship between outcomes was analyzed using Pearson correlation coefficients. Patients were classified as symmetric or asymmetric for each outcome based on an 85% symmetry cutoff. The resulting classifications were qualitatively compared across outcome measures.


      Peak knee extension moment symmetry had a strong association with the force plate symmetry outcomes (r = 0.72–0.96, p < 0.001) and a moderate to strong association with insole symmetry outcomes (r = 0.67–0.77, p < 0.001). There was strong agreement between insole and force plate symmetry outcomes (r = 0.69–0.90, p < 0.001). Four patients were identified as symmetric when using the peak knee extension moment symmetry, five when using force plate data, and eight when using insole data.


      Force sensing insoles could be used as a surrogate for knee extension moment asymmetry in patients who have had an anterior cruciate ligament reconstruction.


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