Clinically Assessed Risk Factors for a Second ACL Injury Using an Innovative Wearable Sensor

使用创新的可穿戴传感器对第二个前交叉韧带损伤的危险因素进行临床评估 项目摘要 每60名青少年运动员中就有近1名会遭受前交叉韧带损伤。这些受伤的运动员中约有90%将 进行ACL重建，估计每年花费30亿美元。在重建和后续 康复允许这些运动员重返运动，他们维持第二次运动的风险增加了15倍 前交叉韧带损伤，前交叉韧带移植物或对侧前交叉韧带在重返运动后的撕裂。许多患者被排除在外 他们的医生恢复运动后，显示出残留的肌肉无力以及不对称的运动 和装填模式。因此，我们认为目前临床回归运动的根本问题 决策是缺乏基于证据的负荷不对称评估方法，可以收集在一个 临床环境。关于不对称的临床相关性的证据已经收集到了基于研究的 动作捕捉实验室。将昂贵且耗时的运动捕捉数据收集包括在 临床环境。尽管基于实验室的证据表明，不对称性(着陆和肌肉力量)增加 二次前交叉韧带损伤的风险，这些测量无法在临床环境中测量以确定 重新做好运动准备。我们的研究有可能显著影响前交叉韧带术后的临床护理 将传统临床和基于临床的新型回归运动措施相结合，以识别患者 增加第二次前交叉韧带损伤的风险，并实现减少前交叉韧带再撕裂的长期目标 通过有针对性的干预。具体地说，我们建议使用以下方法评估临床环境中的负载不对称 一种新的负荷传感鞋垫，用于确定一组创新的基于临床的功能 载荷对称性度量。然后，我们将从一套全面的传统 临床措施(临床特征和神经肌肉表现)和建议的新临床 评估(心理/行为准备和功能负荷对称性)以预测第二前交叉韧带损伤。 我们将招募240名前交叉韧带重建患者用于模型制作，120名前交叉韧带重建患者用于 外部确认(14-25岁)已被释放重返体育界。临床医生评估，患者 自我报告的数据和负载不对称测量将在类似诊所的环境中收集。所有的病人都会 恢复运动后18个月(前交叉韧带重建后24个月)进行完整的损伤监测。 这项观察性研究的目标是：1)确定功能性负荷对称性测量 显著提高对第二个前交叉韧带损伤的预测准确性，超过当前的护理标准临床措施 用于回归体育决策；以及2)从一套全面的传统 临床措施(临床特征和神经肌肉表现)和新的临床评估 (心理/行为准备和功能负荷对称性)预测第二前交叉韧带损伤。研究结果 将为未来的随机多中心研究奠定基础，以确定减少 第二，通过针对性干预造成前交叉韧带损伤。

Clinically Assessed Risk Factors for a Second ACL Injury Using an Innovative Wearable Sensor Project Summary Nearly 1 in 60 adolescent athletes will suffer ACL injuries. Approximately 90% of these injured athletes will undergo an ACL reconstruction at an estimated annual cost of $3 billion. While reconstruction and subsequent rehabilitation allow these athletes to return to sports, they have a 15-fold increased risk of sustaining a second ACL injury, a tear of the ACL graft or the contralateral ACL, upon returning to sports. Many patients cleared to return to sport by their physicians demonstrate residual muscle weakness, as well as asymmetrical movement and loading patterns. Therefore, we contend that the underlying problem with current clinical return to sport decision making is the lack of evidence-based load asymmetry evaluation methods that can be collected in a clinical setting. Evidence about the clinical relevance of asymmetry has been collected in research-based motion capture labs. It is not feasible to include costly and time intensive motion capture data collection in clinical settings. Despite laboratory-based evidence that asymmetries (landing and muscle strength) increase the risk of a second ACL injury, these measures are not able to be measured in clinical settings to determine return to sport readiness. Our study has the potential to significantly impact post-ACL clinical care by identifying the combination of traditional clinical and novel clinic-based return to sport measures that identify patients at high risk for a second ACL injury and achieve our long-term goal of decreasing the number of ACL re-tears through targeted interventions. Specifically, we propose to evaluate load asymmetry in the clinical setting using a new load-sensing insole to determine the predictive associations of an innovative set of clinic-based functional load symmetry measures. We will then develop a prognostic model from a comprehensive set of traditional clinical measures (clinical characteristics and neuromuscular performance) and the proposed novel clinical assessments (psychological/ behavioral readiness and functional load symmetry) to predict second ACL injury. We will recruit 240 ACL reconstructed patients for model development and 120 ACL reconstructed patients for external validation (14-25 years old) who have been released to return to sports. Clinician assessments, patient self-reported data, and load asymmetry measures will be collected in a clinic-like setting. All patients will complete injury surveillance for 18 months following return to sport (24 months following ACL reconstruction). The goals of this observational study are to: 1) Determine whether functional load symmetry measures significantly improve predictive accuracy for a second ACL injury over current standard of care clinical measures used in return to sport decisions; and 2) Develop a prognostic model from a comprehensive set of traditional clinical measures (clinical characteristics and neuromuscular performance) and novel clinical assessments (psychological/ behavioral readiness and functional load symmetry) to predict second ACL injury. Study findings will set the stage for future randomized multi-center studies to determine methods for decreasing the number of second ACL injuries through targeted interventions.