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，基于性别的差异可以在疾病和伤害的易感性中发挥重要作用，但这仍然是一个研究不足的现象。参加跳跃和旋转运动的青少年女性遭受前十字韧带(ACL)损伤的比例是参加相同运动的青少年男性的4到6倍。造成这一前交叉韧带伤情差距的原因(S)还不清楚(S)。在青春期之前，男性和女性受伤的风险似乎是相等的。我们的长期目标是确定女性运动员如何变得更容易受到非接触性前交叉韧带损伤的影响，前瞻性地确定哪些女运动员更容易受到损伤，从生物力学和生化水平确定增加风险的潜在机制原因(S)，并优化旨在预防前交叉韧带损伤的治疗效果。为了实现这些目标，我们建议测试中心假设，在青春期出现的下肢骨长和身体质量的增加，而没有大多数男性所表现出的神经肌肉表现的激增，将增加一部分女性运动员的动态外翻、膝关节负荷和受伤风险。它还将检验这样一种假设，即与动态外翻相关的措施将证明对高危女性运动员的前交叉韧带损伤风险具有预测作用。具体目标1将确定，在青春期发育开始后，在控制膝关节位置和负荷的髋部和膝部肌肉的力量和招募没有增加的情况下，胫骨和股骨长度和身体质量的增加是否会导致神经肌肉控制的减少，这一点通过一组成熟的女运动员动态外翻的增加来衡量。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前交叉韧带损伤的相对风险。我们假设，一个包含动态外翻测量和有助于神经肌肉控制外翻(髋关节内收力矩)和膝关节负荷增加(膝关节外展力矩)的变量的模型将被证明是女性运动员前交叉韧带损伤风险的敏感和特异预测因子。这些数据应该为探讨风险差异背后的机械性问题提供基础，并提高我们指导高危运动员进行有效、有针对性的干预的能力，这是提议的。将女性比例从男性的5倍降低到男性的5倍，这将使每年30,000名女性能够继续享受运动参与的好处，并避免骨关节炎的长期并发症，在前交叉韧带损伤人群中，骨关节炎的发病率可能会高出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.