Can Neuromuscular Training Alter Movement Patterns?

描述(申请人提供)：前十字韧带(ACL)损伤很常见，经常导致不稳定、股四头肌无力和骨关节炎。(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，是否改善结果和减少膝关节前交叉韧带重建后的不良适应在膝骨性关节炎发展的高风险人群中。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，体内运动学、动力学、胫骨平移和基于EMG的关节压缩模型将用于比较。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，非康复者将：1)展示具有动态稳定性的特征的运动和肌肉发射模式，2)这些变化在重建后将持续存在，3)训练诱导的运动和肌肉发射模式的改变将导致重建后更好的功能结果。从这个项目中获得的信息将为每年约10万名美国人的前交叉韧带断裂并接受重建手术的管理提供宝贵的见解。更重要的是，如果术前扰动训练可以改善患者的预后，减少重建前交叉韧带手术后的不良适应，这些发现可能适用于有广泛膝关节损伤的个人。

DESCRIPTION (provided by applicant): 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 improve outcome and reduce maladaptations after ACL reconstruction 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, non-copers will: 1) demonstrate movement and muscle firing patterns that are characteristic of those with dynamic stability, 2) these changes will persist after reconstruction and 3) training induced changes in movement and muscle firing patterns will result in better functional outcomes after reconstruction. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACL's each year and undergo reconstructive surgery. More importantly, if pre-operative perturbation training can facilitate both improved patient outcomes and a reduction in maladaptions following reconstructive ACL surgery, these findings may have applications for individuals with an extensive range of knee injuries.