Knee Loading Asymmetries During Descent and Ascent Phases of Squatting After ACL Reconstruction

Asymmetries are common during squats following anterior cruciate ligament reconstruction (ACLR). This study examined interlimb loading differences between squat phases at 6 months post-ACLR. Thirty-five participants performed bodyweight squats at self-selected speed and were analyzed using 3D motion capture. Vertical ground reaction force impulse (vGRFi), external knee flexion moment impulse (KFMi) and hip-to-knee flexion moment impulse ratio (HKRi) were calculated, along with interlimb ratios (ILR). Squat phase durations were also recorded. Paired t-tests and ANCOVA (controlling for time) were used to compare biomechanical variables across squat phases. Greater asymmetry was observed during ascent for vGRFi ILR (p = 0.045), KFMi ILR (p < 0.001) and HKRi ILR (p = 0.006). The ascent phase was faster than descent (p = 0.036). After adjusting for time, phase-related differences in ILRs were no longer significant. These findings suggest that greater limb and knee-specific loading asymmetries occur during the ascent phase of squats but may be influenced by movement speed. Importantly, significant knee-specific loading asymmetries persisted regardless of squat phase. At 6 months post-ACLR, addressing neuromuscular control and movement speed during rehabilitation may help reduce biomechanical imbalances during closed kinetic chain exercises.