IDENTIFYING FEMALE ATHLETES AT HIGH RISK FOR ACL INJURY

描述（由申请人提供）：现在人们普遍认识到，性别差异在疾病和损伤的易感性中起着重要作用，但这一现象仍未得到充分研究。参加跳跃和旋转运动的青春期女性患前交叉韧带（ACL）损伤的几率是参加相同运动的青春期男性的4到6倍。造成这种前交叉韧带损伤差异的原因尚不清楚。在青春期之前，男性和女性受伤的风险是相等的。我们的长期目标是确定女性运动员是如何变得更容易受到非接触性前交叉韧带损伤的，前瞻性地识别那些更容易受伤的女性运动员，确定生物力学和生化水平上风险增加的潜在机制原因，并优化预防前交叉韧带损伤的治疗效果。为了实现这些目标，我们建议验证一个中心假设，即在青春期下肢骨长和体重的增加，没有大多数男性表现出的神经肌肉表现的爆发，将增加一小部分女性运动员的动态外翻、膝关节负荷和损伤风险。它还将验证与动态外翻相关的测量将证明预测高危女运动员ACL损伤风险的假设。具体目标1将确定是否随着青春期生长的开始，胫骨和股骨长度和体重的增加，在没有力量的增加和臀部和膝盖肌肉组织的补充的情况下，控制膝盖的位置和负荷，将导致神经肌肉控制的下降，这是通过在一个成熟的女性运动员的亚群中增加的动态外翻来测量的。具体目标2将确定客观生物力学指标是否可以预测女性运动员的相对前交叉韧带损伤风险。我们假设，一个包含动态外翻测量和有助于外翻神经肌肉控制的变量（髋关节内收力矩）和膝关节负荷增加（膝关节外伸力矩）的模型将被证明是女性运动员ACL损伤风险的敏感和特定预测因素。这些数据应该为解决潜在风险差异的机制问题提供基础，并提高我们指导高风险运动员进行有效、有针对性干预的能力。将女性的发病率从5倍降至与男性相同，每年将使100万名女性继续从体育运动中获益，并避免骨关节炎的长期并发症，在acl损伤人群中，骨关节炎的发病率可能高出10倍。

DESCRIPTION (provided by applicant): It is now widely recognized that gender-based differences can play a major role in the predisposition to disease and injury, yet this remains an understudied phenomenon. Adolescent females who participate in jumping and pivoting sports suffer anterior cruciate ligament (ACL) injury at a 4 to 6-fold greater rate than adolescent males participating in the same sports. The reason(s) for this ACL injury disparity remain(s) obscure. Prior to puberty, male and female injury risk appears equal. Our long-term objectives are to determine how female athletes become more susceptible to non-contact ACL injury, prospectively identify those female athletes who are more susceptible to injury and to determine the underlying mechanistic cause(s) of increased risk at the biomechanical and biochemical levels and to optimize the effectiveness of treatments designed to prevent ACL injuries. Towards these goals, we propose to test the central hypothesis that the increases in lower extremity bone length and body mass that occur during puberty, without the neuromuscular performance spurt that most males demonstrate, will increase dynamic valgus, knee joint loading and injury risk in a subset of female athletes. It will also test the hypothesis that measures relating to dynamic valgus will prove predictive of ACL injury risk in high-risk female athletes. Specific Aim 1 will determine if following the onset of pubertal growth, increases in tibia and femur length and body mass, in the absence of increases in strength and recruitment of the musculature at the hip and knee that controls knee position and load, will lead to decreased neuromuscular control as measured by increased dynamic valgus in a subset of maturing female athletes. Specific Aim 2 will determine if objective biomechanical measures can predict relative ACL injury risk in female athletes. We hypothesize that a model that incorporates measures of dynamic valgus and variables that contribute to neuromuscular control of valgus (hip adduction moment) and increased knee joint load (knee abduction moment) will prove both sensitive and specific predictors of ACL injury risk in female athletes. These data should provide a foundation for approaching both the mechanistic questions underlying risk disparity, as well as increase our ability to direct high-risk athletes to effective, targeted interventions, which are proposed. Prevention of female rates from 5 times to equal males' would allow >30,000 females annually to continue the benefits of sports participation and to avoid the long-term complications of osteoarthritis, which may occur with a 10-fold greater incidence in the ACL-injured population.