Epidemiology of Jump-landing Movements and ACL Injury

描述（由申请人提供）：尽管进行了大量的研究，前交叉韧带（ACL）损伤的原因仍然难以捉摸，除了简单的观察之外，女性的风险高于男性。我们假设前交叉韧带损伤的病因本质上是多因素的，神经肌肉危险因素起着关键作用。这一假设是由生物力学研究提出的，表明女性风险增加可能主要是由于神经肌肉风险因素，如肌肉力量和人体运动的性别差异。男女之间的这些神经肌肉差异在起跳的落地阶段尤为明显。因此，我们建议在起跳起落时技术不佳作为与性别和前交叉韧带损伤相关的神经肌肉危险因素的有用标记。一个标准化的工具，评分差的起落技术，着陆错误评分系统（LESS），已经开发。经过验证，具有良好的可靠性。本研究将利用LESS、三维运动分析和肌肉力量测试来检查神经肌肉危险因素与前交叉韧带损伤之间的关系。该研究还将检查文献中确定的与前交叉韧带损伤潜在相关的其他危险因素（人口统计学、激素和解剖学），并将比较男女之间跳落地技术不良的患病率和决定因素。该研究将采用前瞻性队列设计。它将在4年内在美国最大的三所军事院校招收4800名男女学员。每位研究参与者将接受基线评估，包括使用运动分析测量神经肌肉危险因素、肌肉力量测试和使用LESS评估跳跃技术。参与者将进行长达4年的随访，以前瞻性地识别和验证ACL损伤。受试者招募和基线测试程序已成功试行。这项前瞻性队列研究的重点是前交叉韧带损伤的神经肌肉危险因素，重点是表现出性别差异的神经肌肉危险因素。该研究还将调查人口统计学、激素和解剖学上的危险因素，这些因素在文献中被认为是导致女性前交叉韧带损伤过多的原因。最终，这项研究将对我们理解前交叉韧带损伤的原因做出重大贡献，特别是关于那些似乎使女性易患前交叉韧带损伤的风险因素。与文献中讨论的一些解剖学和激素危险因素不同，神经肌肉危险因素很容易改变，并且可以进行干预。

DESCRIPTION (provided by applicant): Despite intensive research efforts, the cause of Anterior Cruciate Ligament (ACL) injury remains elusive, beyond the simple observation that women are at higher risk than men. We hypothesize that the etiology of ACL injury is multifactorial in nature, with neuromuscular risk factors playing a critical role. This hypothesis is suggested by biomechanical studies indicating that the increased risk in women may be largely due to neuromuscular risk factors, such as gender differences in muscle strength and human movement. These neuromuscular differences between women and men are particularly evident in the landing phase of a jump. We therefore propose poor technique when landing from a jump (jump-landing) as a useful marker of neuromuscular risk factors associated with both gender and ACL injury. A standardized tool for scoring poor jump-landing technique, the Landing Error Scoring System (LESS), has been developed. It has been validated and has good reliability. This study will utilize the LESS, 3-D motion analysis, and muscle strength testing to examine the association between neuromuscular risk factors and ACL injury. The study will also examine other risk factors (demographic, hormonal, and anatomical) identified in the literature as potentially associated with ACL injury, and will compare the prevalence and determinants of poor jump-landing technique between women and men. The study will use a prospective cohort design. It will enroll 4,800 male and female cadets at the three largest U.S. military academies over a 4 year period. Each study participant will undergo a baseline assessment that includes measurement of neuromuscular risk factors using motion analysis, muscle strength testing, and assessment of jumplanding technique using the LESS. The participants will be followed for up to 4 years with prospective identification and verification of ACL injuries. The subject recruitment and baseline testing procedures have been successfully piloted. This focus of this prospective cohort study is on neuromuscular risk factors for ACL injury, with an emphasis on neuromuscular risk factors that exhibit gender differences. The study will also investigate demographic, hormonal, and anatomical risk factors that have been advanced in the literature as causes of the excess of ACL injuries in women. Ultimately, the research will make a significant contribution to our understanding of the causes of ACL injury, with particular regard to those risk factors that appear to predispose women to ACL injury. Unlike some of the anatomical and hormonal risk factors discussed in the literature, neuromuscular risk factors are readily modifiable and are amenable to intervention.