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ACL injury mechanisms & offaxis neuromuscular diagnosis & training

ACL损伤机制

基本信息

批准号：
7924072
负责人：
Li-Qun Zhang
金额：
$ 36.53万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-01 至 2013-08-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): ACL is the most commonly injured knee ligament in sports-related activities, especially in pivoting sports. ACL injury mechanisms, including factors contributing to the 2-9 times higher incident rate in female athletes than their male counterparts, are still not very clear. Considering off-axis knee motions (tibial rotation and valgus/varus) are rather limited and there may be gender differences in off-axis properties, ACL injuries are often associated with excessive off-axis loadings. Objectives: To investigate off-axis neuromechanical and anatomical properties of noncontact ACL injuries in men and women, and to conduct intervention training based on the diagnosis to improve neuromuscular control of risky, potentially injurious off-axis movements. Hypothesis 1: Females have lower stability, stiffness and strength, greater joint laxity, and less sensitive proprioception in external and internal tibial rotations and in valgus and varus than males. Specific Aim 1: To perform a pre-training diagnosis of knee off-axis neuromechanical properties in females and males using custom knee devices for off-axis evaluations and a novel pivoting-sliding elliptical machine. Clinical/functional measures will also be conducted. Hypothesis 2: Females are more likely to have ACL impingement than males under external tibial rotation and valgus loading, characterized by a subject-specific FE impingement modeling. Specific Aim 2: To determine the susceptibility of ACL impingement against the lateral notch wall during external tibial rotation and valgus in individuals using a 3-D FE ACL-impingement model. Hypothesis 3: Subject-specific training on a pivoting-sliding elliptical exercise machine based on the diagnosis improves off-axis neuromuscular control. Specific Aim 3: To conduct subject-specific pivoting-sliding elliptical training and improve off-axis neuromuscular control, based on the pre-training diagnosis. Specific Aim 4: To determine training-induced neuromechanical and functional changes. Study Design Setting: Off-axis neuromechanical properties will be determined for individual subjects. An intervention program will be conducted accordingly. Setting: A research lab for neuromechanical evaluations, and school gym for training/evaluation. Participants: 60 female and 60 male athletes from local high school and youth sports teams. Interventions: Training off-axis neuromuscular control using a novel pivoting-sliding elliptical machine. Training will be done in three 40-minute training session per week for 6 weeks. Outcome Measures: Stability, muscle strength, stiffness, laxity, proprioception, and reaction time in tibial rotation (pivoting) and in valgus/varus, functional activities, and incidence of ACL injuries. PUBLIC HEALTH RELEVANCE: The proposed studies will conduct subject-specific diagnosis on off-axis neuromechanical properties in internal and external rotations and in valgus/varus in individual female and male subjects, and perform subject-specific intervention training of off-axis neuromuscular control based on the diagnosis, using a novel pivoting-sliding elliptical machine.

描述（由申请人提供）：ACL是运动相关活动中最常见的膝关节韧带损伤，尤其是在旋转运动中。ACL损伤的机制，包括导致女性运动员发生率比男性运动员高2-9倍的因素，仍然不太清楚。考虑到离轴膝关节运动（胫骨旋转和外翻/内翻）相当有限，并且离轴特性可能存在性别差异，ACL损伤通常与过度离轴载荷相关。目的：研究男性和女性非接触性ACL损伤的离轴神经力学和解剖学特性，并根据诊断进行干预训练，以改善神经肌肉对危险、潜在伤害性离轴运动的控制。假设1：与男性相比，女性的稳定性、刚度和强度较低，关节松弛度较大，胫骨外旋和内旋以及外翻和内翻时的本体感觉较不敏感。具体目标1：使用用于离轴评价的定制膝关节器械和新型双摆-滑动椭圆机，对女性和男性的膝关节离轴神经力学特性进行训练前诊断。还将进行临床/功能测量。假设二：在胫骨外旋和外翻载荷下，女性比男性更容易发生ACL撞击，其特征在于受试者特定的FE撞击建模。具体目标二：使用三维有限元ACL撞击模型确定个体胫骨外旋和外翻时ACL撞击外侧切迹壁的敏感性。假设三：根据诊断结果，在椭圆运动机上进行针对特定对象的训练，可改善离轴神经肌肉控制。具体目标3：在训练前诊断的基础上，进行特定科目的蹬冰-滑行椭圆训练，提高离轴神经肌肉控制能力。具体目标4：确定训练引起的神经力学和功能变化。研究设计设置：将确定个体受试者的离轴神经力学特性。将相应地实施干预方案。设置：神经力学评估的研究实验室，和学校体育馆的培训/评估。参加者：来自当地高中和青年运动队的60名女运动员和60名男运动员。干预措施：使用一种新型的摆动-滑动椭圆机训练离轴神经肌肉控制。培训将在每周三次40分钟的培训课程中进行，为期6周。结果测量：稳定性、肌力、刚度、松弛度、本体感觉、胫骨旋转（旋转）和外翻/内翻反应时间、功能活动和ACL损伤发生率。公共卫生相关性：拟开展的研究将对个体女性和男性受试者的内旋和外旋以及外翻/内翻的离轴神经力学特性进行受试者特异性诊断，并基于诊断，使用一种新型的旋转-滑动椭圆机进行离轴神经肌肉控制的受试者特异性干预训练。