MiACLR: Michigan Initiative for Anterior Cruciate Ligament Rehabilitation

摘要 前交叉韧带重建（ACLR）后恢复股四头肌肌肉力量可能会有所帮助 预防创伤后膝关节骨关节炎，超过50%的膝关节在手术后10 - 20年受到影响 重建然而，我们对如何最大限度地提高肌肉力量的理解存在根本性的差距 ACLR后，由于目前的康复无法恢复对称的股四头肌力量。我们的试点工作 表明，当患者恢复活动时，股四头肌力量约为未受伤侧的70%， 低于推荐的90%。此外，我们的数据表明，嵌入高强度神经肌肉 将电刺激（NMES）和离心运动纳入标准护理ACL康复中， 与单独标准治疗相比，股四头肌力量。然而，这些药物的真正功效 干预措施是未知的，因为我们目前缺乏足够样本量的对照试验。没有 这些信息是拟议试验的驱动力和焦点。因此，我们提出了一个双重- 盲态随机对照试验，ACLR患者将被随机分配至4个治疗组中的1个。研究组将 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;和4）8周NMES安慰剂+8周偏心运动;和 几周的古怪安慰剂所有研究组将接受ACL康复标准治疗， 研究干预措施。我们假设接受NMES+离心运动（第1组）的受试者将意识到， ACLR后6个月时的力量和生物力学功能改善大于ACLR组患者， 其他3个研究组。此外，我们预计NMES+离心运动组（组1）的患者将最好地 消除ACLR后18个月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后强度损失的主要机制的干预措施 并且还将评估改善肌肉力量是否可以最小化软骨健康的早期变化， 这可能是未来骨关节炎的征兆。这项研究很重要，因为它将确定 循证治疗方法，可以成功地抵消肌肉无力，困扰 ACLR患者在受伤后持续数年，并导致创伤后骨关节炎的发生。

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.