MiACLR: Michigan Initiative for Anterior Cruciate Ligament Rehabilitation

摘要 前交叉韧带重建术(ACLR)后股四头肌肌力恢复可能有帮助 预防手术后10-20年影响50%以上膝关节的创伤后膝骨性关节炎 重建。然而，在我们对如何最大化肌肉力量的理解上存在着根本的差距。 ACLR后，由于目前的康复治疗未能恢复股四头肌的对称性力量。我们的试点工作 显示当患者恢复活动时，股四头肌力量是健侧的~70%，这是很远的 低于推荐的90%。此外，我们的数据表明，嵌入高强度的神经肌肉 电刺激(NMES)和离心性运动纳入标准护理前交叉韧带康复导致更高 与单独的护理标准相比，股四头肌的力量。然而，这些药物的真正功效 干预措施未知，因为我们目前缺乏具有足够样本量的对照试验。不存在 这些信息是拟议审判的驱动力和重点。因此，我们建议双倍- 盲法随机对照试验，将ACLR患者随机分成4组中的1组。学习武器的意志 包括：1)8周的NMES+8周的离心运动；2)8周的NMES安慰剂+8周的 偏心运动；3)8周NMES+8周偏心安慰剂；4)8周NMES安慰剂+8 连续数周服用古怪的安慰剂。所有学习臂将接受标准护理的前交叉韧带康复除 研究干预。我们假设，接受NMES+离心性运动(ARM 1)的受试者将意识到 ACLR术后6个月的力量和生物力学功能的改善比 其他3个学习臂。此外，我们预计NMES+离心式运动臂(臂1)的患者将是最好的 在ACLR术后18个月消除软骨健康的负面变化。这项研究具有创新性，因为 它采用直接针对导致ACLR后力量丧失的主要机制的干预措施 还将评估提高肌肉力量是否可以将软骨健康的早期变化降至最低， 这可能预示着未来的骨性关节炎。这项拟议的研究意义重大，因为它将确定 循证治疗方法可以成功地抵消困扰肌肉无力的疾病 ACLR患者在受伤后多年，并有助于创伤后骨关节炎的发病。

ABSTRACT Restoring quadriceps muscle strength following anterior cruciate ligament reconstruction (ACLR) may help prevent the post-traumatic knee osteoarthritis that affects over 50% of knees 10-20 years after surgical reconstruction. However, a fundamental gap exists in our understanding of how to maximize muscle strength following ACLR, as current rehabilitation fails to restore symmetrical quadriceps strength. Our pilot work shows that when patients return to activity, quadriceps strength is ~70% of the uninjured side, which is far below the recommended 90%. Further, our data suggest that embedding high-intensity neuromuscular electrical stimulation (NMES) and eccentric exercise into standard of care ACL rehabilitation leads to higher quadriceps strength when compared with standard of care alone. However, the true efficacy of these interventions is unknown, as we currently lack controlled trials with adequate sample sizes. The absence of this information serves as the driving force and focus of the proposed trial. Therefore, we propose a double- blind randomized controlled trial where ACLR patients will be randomized to 1 of 4 arms. Study arms will include: 1) 8 weeks of NMES+8 weeks of eccentric exercise; 2) 8 weeks of NMES placebo+8 weeks of eccentric exercise; 3) 8 weeks of NMES+8 weeks of eccentric placebo; and 4) 8 weeks of NMES placebo+8 weeks of eccentric placebo. All study arms will receive standard of care ACL rehabilitation in addition to the study interventions. We hypothesize that subjects receiving NMES+eccentric exercise (Arm 1) will realize greater improvements in strength and biomechanical function at 6 months following ACLR than patients in the other 3 study arms. Further, we anticipate that patients in the NMES+eccentric exercise arm (Arm 1) will best eliminate negative changes in cartilage health at 18 months following ACLR. This study is innovative, because it employs interventions that directly target the primary mechanisms that result in strength loss following ACLR and will also evaluate whether improving muscle strength can minimize early changes in cartilage health, which may be indicative of future osteoarthritis. The proposed research is significant because it will identify evidence-based treatment approaches that can successfully counteract the muscle weakness which plagues ACLR patients for years after injury and contributes to the onset of post-traumatic osteoarthritis.