Can we modify gait asymmetry after ACL reconstruction?

项目摘要/摘要 在美国，每年有超过25万人撕裂前十字韧带(ACL)， 大多数人随后接受了外科重建(ACLR)。尽管进行了广泛的康复，但个人 ACLR术后坚持不对称膝关节力学行走。即使在前交叉韧带重建数年后， 在重返体育活动很久之后，个人走路时会有微妙的步态不对称 临床上可被个体察觉或察觉到的。然而，这些微小的不对称直接导致了 可发展为早发性、创伤性膝关节骨性关节炎。创伤后膝关节 骨关节炎发生在前交叉韧带损伤后5-15年，对个体具有毁灭性的影响。早些时候 骨关节炎与运动和娱乐活动减少、疼痛和自卑直接相关。 报告的生活质量。由于前交叉韧带断裂和重建的高峰年龄为女孩16岁和17岁 男孩年纪大了，大多数人都有可能在成年后患上膝骨性关节炎。这样做的目的是 奖学金是应用运动学习的原理直接针对不对称的膝关节力学在 ACLR之后的个人。使用分裂腰带(一条腰带下的一条腰带)短期内改变行走机制的潜力 每只脚以不同的速度移动)跑步机已经在神经学和未受伤的情况下得到证实 人口。该奖学金将使用分带跑步机适应范例来理解个人如何 前交叉韧带重建后适应膝关节力学。此外，这项工作将评估一轮 分体带跑步机训练通过量化膝关节动力学和运动参数的变化来实现地面行走对称性 运动学。具体地说，该提案将确定ACLR后个人能够适应的程度(AIM 1)保留(目标2)和地面转移(目标3)与未受伤相比改善膝关节力学 个人。这项工作将为ACLR后个体的运动学习提供有价值的见解。 对纠正有害的行走机制是必要的。这位奖学金申请者的长期目标是 制定有针对性的干预措施，优化步态，最终降低创伤后膝伤的发生率 ACLR后的骨性关节炎。拟议工作的结果将有助于康复干预措施的设计 用于术后早期前交叉韧带的康复。这项研究有可能促进手术后的体格检查 治疗干预和影响早发性膝骨性关节炎的发展，潜在地改善 ACLR术后的活动水平和生活质量。此外，这项建议将便利申请人的博士前研究 培训，为成为一名独立的临床医生-科学家奠定了职业基础。

PROJECT SUMMARY/ABSTRACT More than a quarter of a million people in the US tear their anterior cruciate ligaments (ACL) each year, and most subsequently undergo surgical reconstruction (ACLR). Despite extensive rehabilitation, individuals persistently walk with asymmetrical knee joint mechanics after ACLR. Even years after ACL reconstruction, long after they have returned to sporting activities, individuals walk with subtle gait asymmetries that are not clinically detectable or perceived by the individual. These small asymmetries, nevertheless, directly contribute to the development of early-onset, post-traumatic knee joint osteoarthritis. Post-traumatic knee joint osteoarthritis develops 5-15 years after ACL injury and carries devastating implications for the individual. Early osteoarthritis is directly associated with decreased sports and recreational participation, pain, and lower self- reported quality of life. As the peak age of ACL rupture and reconstruction is 16 years old in girls and 17 years old in boys, most are on track to develop knee osteoarthritis in young adulthood. The objectives of this fellowship are to apply principles of motor learning to directly target the asymmetric knee joint mechanics in individuals after ACLR. The potential to change walking mechanics short-term using a split-belt (one belt under each foot moving at different speeds) treadmill has been demonstrated in neurologic and uninjured populations. This fellowship will use a split-belt treadmill adaptation paradigm to understand how individuals after ACL reconstruction adapt knee joint mechanics. Further, this work will assess the carry-over of a bout of split-belt treadmill training on over-ground walking symmetry by quantifying changes in knee joint kinetics and kinematics. Specifically, the proposal will determine the extent to which individuals after ACLR can adapt (Aim 1) retain (Aim 2), and overground transfer (Aim 3) improved knee joint mechanics compared to uninjured individuals. This work will provide valuable insight into motor learning in individuals after ACLR, which is necessary to correct detrimental walking mechanics. The long-term goal of this fellowship applicant is to develop targeted interventions to optimize gait and ultimately reduce the rate of posttraumatic knee osteoarthritis after ACLR. Findings from the proposed work will aid in the design of rehabilitation interventions for early post-operative ACL rehabilitation. This research has potential to advance post-operative physical therapy interventions and affect the development of early-onset knee osteoarthritis, potentially improving activity levels and quality of life after ACLR. Further, this proposal will facilitate the applicant’s predoctoral training, laying the foundation for a career as an independent clinician-scientist.