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临床评估第二次ACL损伤的风险因素 项目摘要 每60名青少年运动员中就有1人会遭受ACL损伤。大约90%的受伤运动员将 进行ACL重建，估计每年花费30亿美元。虽然重建和随后的 康复使这些运动员能够重返运动场，但他们遭受第二次伤病的风险增加了15倍 ACL损伤，ACL移植物或对侧ACL撕裂，恢复运动后。许多患者被允许 恢复运动的医生表现出残余的肌肉无力，以及不对称的运动 和加载模式。因此，我们认为，目前临床回归运动的根本问题是， 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 临床设置。关于不对称的临床相关性的证据已经在基于研究的 动作捕捉实验室将昂贵且时间密集的运动捕捉数据收集包括在其中是不可行的。 临床环境。尽管实验室证据表明，不对称（着陆和肌肉力量）增加 第二次ACL损伤的风险，这些措施无法在临床环境中测量，以确定 回到体育准备。我们的研究有可能通过识别ACL后的临床护理， 结合传统的临床和新的基于临床的恢复运动的措施，确定患者在 第二次ACL损伤的高风险，并实现我们减少ACL再撕裂数量的长期目标 通过有针对性的干预。具体来说，我们建议在临床环境中使用以下方法评估负荷不对称性： 一种新的负荷传感鞋垫，以确定一套创新的基于临床的功能的预测协会， 负载对称性测量。然后，我们将开发一个预测模型，从一个全面的传统的 临床指标（临床特征和神经肌肉性能）和拟定的新临床指标 评估（心理/行为准备和功能负荷对称性）以预测第二次ACL损伤。 我们将招募240名ACL重建患者用于模型开发，120名ACL重建患者用于 外部验证（14 - 25岁），他们已被释放返回体育界。临床医生评估，患者 将在类似诊所的环境中收集自我报告的数据和负荷不对称测量。所有患者将 恢复运动后18个月（ACL重建后24个月）完成损伤监测。 这项观察性研究的目的是：1）确定功能负荷对称性是否测量 与当前标准护理临床测量相比，显著提高了对第二次ACL损伤预测准确性 用于返回到体育决策;和2）从一套全面的传统的预测模型， 临床指标（临床特征和神经肌肉性能）和新型临床评估 （心理/行为准备和功能负荷对称性）预测第二次ACL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ACL损伤通过有针对性的干预。

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.