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，基于性别的差异在疾病和损伤的易感性中起着重要作用，但这仍然是一个未充分研究的现象。参加跳跃和旋转运动的青少年女性遭受前交叉韧带（ACL）损伤的比率比参加相同运动的青少年男性高4至6倍。这种ACL损伤差异的原因仍然不清楚。在青春期之前，男性和女性受伤的风险似乎相等。我们的长期目标是确定女性运动员如何更容易受到非接触性ACL损伤的影响，前瞻性地识别那些更容易受伤的女性运动员，并确定生物力学和生化水平风险增加的潜在机械原因，并优化旨在预防ACL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，即在青春期发生的下肢骨长度和体重的增加，而不是大多数男性表现出的神经肌肉性能突增，将增加动态外翻，膝关节负荷和受伤的风险在一个子集的女性运动员。它还将测试的假设，有关动态外翻的措施将证明预测ACL损伤的风险，在高风险的女运动员。具体目标1将确定在青春期生长开始后，胫骨和股骨长度以及体重的增加，在控制膝关节位置和负荷的髋关节和膝关节肌肉组织的力量和募集没有增加的情况下，是否会导致神经肌肉控制降低，如在成熟女性运动员子集中增加的动态外翻所测量的。具体目标2将确定客观的生物力学指标是否可以预测女性运动员的相对ACL损伤风险。我们假设，一个模型，结合措施的动态外翻和变量，有助于外翻（髋关节内收力矩）和增加膝关节负荷（膝关节外展力矩）的神经肌肉控制，将被证明是敏感和具体的预测因子ACL损伤的风险，在女性运动员。这些数据应该为接近潜在风险差异的机械问题提供基础，并提高我们指导高风险运动员进行有效，有针对性的干预措施的能力。将女性发病率从5倍降低到与男性相同，将使每年超过30 000名女性继续受益于体育参与，并避免骨关节炎的长期并发症，骨关节炎在ACL受伤人群中的发病率可能高出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.