OSTEOBLAST AND ADIPOCYTE DIFFERENTIATION BY FOSB

前交叉韧带(ACL)损伤较为常见，常导致不稳定、股四头肌无力和骨性关节炎。(OA)许多慢性前交叉韧带缺陷者在前交叉韧带断裂数年后有膝骨性关节炎的证据。那些不能很好地补偿前交叉韧带缺陷的人(非铜病患者)所经历的虚弱和不稳定会导致补偿策略，这可能会加速或恶化膝骨性关节炎。这些糟糕的补偿策略在手术重建后并不能统一解决，那些接受重建的人也有更高的患膝骨性关节炎的风险。这项工作的总体目标是确定有效的康复计划以动态稳定膝关节是否能减少导致膝骨性关节炎的适应性，这些适应性导致膝关节骨关节炎的发展风险很大。计划进行手术的80名前交叉韧带断裂患者将被随机分配到一组，其中包括一种称为扰动训练的神经肌肉训练形式，或标准组。他们将在手术前后使用运动分析和X线片进行评估。运动学、动力学、胫骨平移和基于肌电的关节压缩模型的活体测量将用于比较。这项随机试验旨在证明，在包括扰动训练在内的术前康复后，非康复者采用的运动模式：1)显示出改善关节稳定性和减少肌肉协同收缩的能力，2)重建后仍能持续，3)重建后功能转归更好，4)与标准的术前治疗策略相比，随着时间的推移，膝关节疼痛和骨关节炎的发展较少。来自该项目的信息将为每年约100,000名美国人的ACL破裂并接受重建手术的管理提供宝贵的见解。更重要的是，如果扰动训练计划诱导膝关节动态稳定的能力实际上产生了关节保护，那么将其应用于其他有可能发展成膝骨性关节炎的人可能有助于减少这种致残的临床情况的发生率。

Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Many of those with chronic ACL deficiency have evidence of knee OA years after ACL rupture. Weakness and instability experienced by those who do not compensate well for ACL deficiency (non-copers) independently lead to compensation strategies that could precipitate or worsen knee OA. These poor compensation strategies do not uniformly resolve after surgical reconstruction and those who undergo reconstruction also have an increased risk of developing knee OA. The overall goal of this work is to determine whether effective rehabilitation programs to dynamically stabilize the knee reduce the adaptations that lead to osteoarthritis in a population at great risk for the development of knee OA. Eighty individuals with ACL rupture who are scheduled for surgery will be randomly assigned to a group that includes a form of neuromuscular training called perturbation training, or a standard group. They will be evaluated before and after surgery using motion analysis and radiography. In vivo measures of kinematics, kinetics, tibial translation and EMG based models of joint compression will be used for comparison. This randomized trial is designed to demonstrate that, after preoperative rehabilitation that includes perturbation training, movement patterns adopted by non-copers: 1) demonstrate improve joint stability and reduced muscle cocontraction, 2) persist after reconstruction and 3) result in better functional outcomes after reconstruction and 4) lead to the development of less knee pain and OA over time than standard preoperative treatment strategies. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACLs each year and undergo reconstructive surgery. More importantly, if the perturbation training program's ability to induce dynamic knee stability actually results in joint protection, its application to others at risk for the development knee OA may help reduce the incidence of this disabling clinical condition.