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. 2025 Jun 1;18(4):636-658.
doi: 10.70252/UWHV9758. eCollection 2025.

Sedentary Behavior Patterns After ACL Reconstruction

David M Werner  1   2   3 , Liubov Arbeeva  4 , Yvonne M Golightly  1   2   5 , Balasrinivasa R Sajja  6 , Michael D Rosenthal  2 , Matthew Tao  2   7 , Elizabeth Wellsandt  2   7
Affiliations

Sedentary Behavior Patterns After ACL Reconstruction

David M Werner et al. Int J Exerc Sci. .

Abstract

Individuals after anterior cruciate ligament reconstruction (ACLR) are less physically active than their uninjured peers, but little is known about their sedentary behavior (SB). This study aimed to identify patterns of SB in individuals six and 18 months after ACLR. Eighteen individuals after ACLR wore accelerometers for one week during six- and 18-month post-operative assessments (83.3% female, 19.7±5.6 years old, BMI 23.9±kg/m2). The percentage of awake time spent in SB was estimated. A multilevel (two time points - six and 18 months), multidimensional (13 hours) functional principal component analysis generated two sets of unique personalized principal component scores: between-participant (person level principal components, PPC) and within-participant (follow-up level principal components, FPC). An exploratory analysis compared SB patterns with structural and symptomatic signs of knee health outcomes. Participants averaged 65.4±7.5% and 65.7±9.0% time in SB at six and 18 months after ACLR, respectively. The first PPC identified an overall pattern of high levels of SB throughout the day. The first FPC identified a pattern of decreased SB in the morning and increased SB in the evening 18 months after ACLR compared to six months. Our exploratory analysis identified a potential association between this first FPC and knee health symptoms 18 months after ACLR. Different SB patterns existed six months after ACLR. Our findings suggest the time of day when individuals after ACLR are most sedentary and provide a foundation to develop and test interventions to reduce time in SB by substituting periods of physical activity.

Keywords: Physical activity; exercise; outcomes.

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Figures

Figure Appendix 1a
Figure Appendix 1a
Participant-Level Principal Components and Lateral Femoral Cartilage T2 Relaxation Time Graphical depiction of participant-level components (PPCs). The x- and y-axis values are the associated PPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the lateral femoral cartilage.
Figure Appendix 1b
Figure Appendix 1b
Participant-Level Principal Components and Lateral Tibial Cartilage T2 Relaxation Time Graphical depiction of participant-level components (PPCs). The x- and y-axis values are the associated PPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the lateral tibial cartilage.
Figure Appendix 1c
Figure Appendix 1c
Participant-Level Principal Components and Medial Femoral Cartilage T2 Relaxation Time Graphical depiction of participant-level components (PPCs). The x- and y-axis values are the associated PPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the medial femoral cartilage.
Figure Appendix 2
Figure Appendix 2
Box and whisker plots of the mean correlation with each participant level principal component separated by knee function group.
Figure Appendix 3a
Figure Appendix 3a
Follow-up Level Principal Components and Lateral Femoral Cartilage T2 Relaxation Time Graphical depiction of follow-up level components (FPCs). The x- and y-axis values are the associated FPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the lateral femoral cartilage.
Figure Appendix 3b
Figure Appendix 3b
Follow-up Level Principal Components and Lateral Tibial Cartilage T2 Relaxation Time Graphical depiction of follow-up level components (FPCs). The x- and y-axis values are the associated FPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the lateral tibial cartilage.
Figure Appendix 3c
Figure Appendix 3c
Follow-up Level Principal Components and Medial Femoral Cartilage T2 Relaxation Time Graphical depiction of follow-up level components (FPCs). The x- and y-axis values are the associated FPC values for each participant. The shade of the dot represents the strength and direction of the percent change of T2 relaxation time for the medial femoral cartilage.
Figure 1
Figure 1
MRI of a participant demonstrating: a) pixel by pixel T2 relaxation map, and b) articular cartilage regions of interest (teal is weightbearing portion of femoral cartilage, pink is weightbearing portion of tibial cartilage).
Figure 2
Figure 2
Participant-level principal components (PPCs) for the first four PPCs. Values to the above the x-axis (>0) indicate an increase in sedentary behavior compared to the sample mean at that hour, whereas values below the x-axis (<0) indicate a decrease in sedentary behavior compared to the sample mean at that hour. Abbreviations: SB: sedentary behavior
Figure 3
Figure 3
Follow-up-level principal components (FPCs) for the first four FPCs. Values above the x-axis (>0) indicate an increase in sedentary behavior at 18 months compared to the sample mean at 6 months, whereas values below the x-axis (<0) indicate a decrease in sedentary behavior at 18 months compared to the sample mean at 6 months. Abbreviations: SB: sedentary behavior
Figure 4
Figure 4
Box and whisker plots of the mean correlation with each participant level principal component separated by knee function group. Adequate knee function = >90% quadriceps strength symmetry and >90% on the International Knee Documentation Committee form
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References

    1. Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg. 2015;28(5):390–394. doi: 10.1055/s-0035-1544193. - DOI - PubMed
    1. Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT. Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002–2014. Sports Health. 2018;10(6):523–531. doi: 10.1177/1941738118803616. - DOI - PMC - PubMed
    1. Dahduli OS, AlHossan AM, Al Rushud MA, et al. Early surgical reconstruction versus rehabilitation for patients with anterior cruciate ligament rupture: A Systematic review and meta-analysis. Cureus. 2023;15(8):e43370. doi: 10.7759/cureus.43370. - DOI - PMC - PubMed
    1. Luc B, Gribble PA, Pietrosimone BG. Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train. 2014;49(6):806–819. doi: 10.4085/1062-6050-49.3.35. - DOI - PMC - PubMed
    1. Harkey MS, Baez S, Lewis J, et al. Prevalence of early knee osteoarthritis illness among various patient-reported classification criteria after anterior cruciate ligament reconstruction. Arthritis Care Res (Hoboken) 2022;74(3):377–385. doi: 10.1002/acr.24809. - DOI - PubMed

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