Can we modify gait asymmetry after ACL reconstruction?

项目总结/摘要 在美国，每年有超过25万人的前十字韧带（ACL）撕裂， 大多数随后进行手术重建（ACLR）。尽管进行了广泛的康复， ACLR后持续行走，膝关节力学不对称。即使在前交叉韧带重建多年后， 在他们恢复体育活动很长时间后，人们走路时会出现微妙的步态不对称， 临床上可检测到或被个体感知到。然而，这些小的不对称性直接导致了 早发性创伤后膝关节骨关节炎的发展。创伤后膝关节 骨关节炎在ACL损伤后5-15年发展，并对个体带来毁灭性的影响。早期 骨关节炎与运动和娱乐参与减少、疼痛和自我意识降低直接相关。 报告的生活质量。由于ACL断裂和重建的高峰年龄在女孩中为16岁， 在男孩中，大多数人在年轻时发展为膝关节骨关节炎。这一目标 奖学金是应用运动学习的原则，直接针对不对称的膝关节力学， ACLR后的人使用分离式安全带（下一条安全带）短期内改变行走力学的潜力 每只脚以不同的速度移动）跑步机已被证明在神经和未受伤 人口数量。这个奖学金将使用分裂带跑步机适应范例，以了解个人如何 ACL重建后适应膝关节力学。此外，这项工作将评估一轮的结转， 通过量化膝关节动力学的变化， 运动学具体而言，该提案将确定ACLR后个人可以适应的程度（Aim 1)与未受伤者相比，保留（目标2）和地上转移（目标3）改善了膝关节力学 个体这项工作将为ACLR后个体的运动学习提供有价值的见解， 必须纠正有害的步行力学。本奖学金申请人的长期目标是 制定有针对性的干预措施，以优化步态，并最终降低创伤后膝关节 ACLR后的骨关节炎从拟议的工作结果将有助于康复干预措施的设计 术后早期ACL康复。这项研究有可能促进术后身体健康 治疗干预和影响早发性膝关节骨关节炎的发展，可能改善 ACLR后的活动水平和生活质量。此外，这项建议将有利于申请人的博士预科 培训，奠定了作为一个独立的临床科学家的职业生涯的基础。

PROJECT SUMMARY/ABSTRACT More than a quarter of a million people in the US tear their anterior cruciate ligaments (ACL) each year, and most subsequently undergo surgical reconstruction (ACLR). Despite extensive rehabilitation, individuals persistently walk with asymmetrical knee joint mechanics after ACLR. Even years after ACL reconstruction, long after they have returned to sporting activities, individuals walk with subtle gait asymmetries that are not clinically detectable or perceived by the individual. These small asymmetries, nevertheless, directly contribute to the development of early-onset, post-traumatic knee joint osteoarthritis. Post-traumatic knee joint osteoarthritis develops 5-15 years after ACL injury and carries devastating implications for the individual. Early osteoarthritis is directly associated with decreased sports and recreational participation, pain, and lower self- reported quality of life. As the peak age of ACL rupture and reconstruction is 16 years old in girls and 17 years old in boys, most are on track to develop knee osteoarthritis in young adulthood. The objectives of this fellowship are to apply principles of motor learning to directly target the asymmetric knee joint mechanics in individuals after ACLR. The potential to change walking mechanics short-term using a split-belt (one belt under each foot moving at different speeds) treadmill has been demonstrated in neurologic and uninjured populations. This fellowship will use a split-belt treadmill adaptation paradigm to understand how individuals after ACL reconstruction adapt knee joint mechanics. Further, this work will assess the carry-over of a bout of split-belt treadmill training on over-ground walking symmetry by quantifying changes in knee joint kinetics and kinematics. Specifically, the proposal will determine the extent to which individuals after ACLR can adapt (Aim 1) retain (Aim 2), and overground transfer (Aim 3) improved knee joint mechanics compared to uninjured individuals. This work will provide valuable insight into motor learning in individuals after ACLR, which is necessary to correct detrimental walking mechanics. The long-term goal of this fellowship applicant is to develop targeted interventions to optimize gait and ultimately reduce the rate of posttraumatic knee osteoarthritis after ACLR. Findings from the proposed work will aid in the design of rehabilitation interventions for early post-operative ACL rehabilitation. This research has potential to advance post-operative physical therapy interventions and affect the development of early-onset knee osteoarthritis, potentially improving activity levels and quality of life after ACLR. Further, this proposal will facilitate the applicant’s predoctoral training, laying the foundation for a career as an independent clinician-scientist.