Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes

针对女运动员 ACL 负荷机制的神经肌肉干预

• 批准号: 7665088
• 负责人: Timothy E Hewett
• 金额: $ 64.76万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7665088
• 关键词: Address; Anterior Cruciate Ligament; Biomechanics; Body Weight; Data; Degenerative polyarthritis; Double-Blind Method; Drops; Educational Intervention; Evidence based intervention; Exercise; Female; Goals; Hip region structure; Injury; Intervention; Knee; Lateral; Leg; Limb structure; Link; Manufactured basketball; Medial; Motion; Positioning Attribute; Randomized Controlled Trials; Reaction; Relative (related person); Risk; Sensitivity and Specificity; Soccer; Specificity; Sports; Testing; Torque; Training; Training Programs; Validation; Women' s Group; Work; combinatorial; design; evidence base; foot; high risk; injured; ligament injury; male; neuromuscular; public health relevance; therapy design; vector

DESCRIPTION (provided by applicant): Females who participate in cutting and landing sports suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Fifty to 100 percent of ACL injured females will suffer osteoarthritis of the injured knee within one to two decades of the injury. External knee abduction moment (LOAD) predicts ACL injury with high sensitivity and specificity in female athletes. Control of lateral trunk motion (LTM) also predicts ACL injury with similar levels of sensitivity and specificity in female athletes. These predictors may be linked, as lateral positioning of the trunk can induce knee abduction load via both biomechanical and neuromuscular mechanisms. The mechanism of ACL injury in females most often includes high knee LOAD and high LTM, with the majority of body weight shifted over the injured limb and the foot positioned lateral to the body's center of mass. An unanticipated perturbation is also often a contributor to the injury mechanism. LTM may result in increased knee LOAD via lateral positioning and increased magnitude of the GRF vector ( GRFv) or by altered reactive hip adductor torque (HAdT). Our long-term objectives are to determine the mechanisms that increase ACL injury risk in female athletes and to develop neuromuscular training (NMT) interventions that specifically target these mechanisms. If the objectives of this proposal are achieved, an evidence-based NMT intervention will be developed and made available nationally that will effectively and efficiently reduce ACL injury risk in high-risk female athletes. The major goal of this proposal is to determine if increased LTM alters LOAD in female athletes. This application will test the central hypotheses that LTM increases knee LOAD and that NMT that is targeted toward increasing coronal plane control of trunk motion will decrease LOAD in females. Aim 1 is designed to determine the mechanisms by which trunk motion may increase knee LOAD in female athletes. Coronal plane control of the trunk (LTM) will be examined relative to GRFv, HAdT and knee LOAD. We will determine if increased LTM increases knee LOAD via biomechanical (increased GRFv) and/or neuromuscular (increased relative HAdT) mechanisms. The central hypothesis of Aim 1 is that increased LTM will increase knee LOAD in female athletes by increasing GRFv, by increasing HAdT or via a combination of these mechanisms during cutting and landing. We hypothesize that females with neither mechanism will have low knee LOAD, those with increased GRFv or HAdT will have moderate LOAD and those with increased GRFv and HAdT will have high knee LOAD. Aim 2 is designed to determine if NMT targeted to decreases coronal plane trunk motion (TNMT) will decrease both LTM and knee LOAD to a greater extent than sham/control training in a randomized controlled trial (RCT). The primary hypothesis of Aim 2 is that TNMT will decrease LTM and knee LOAD. Secondary hypotheses will test relationships between changes in LTM, GRFv, HAdT and LOAD with TNMT using Post-Hoc analysis. Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes. PUBLIC HEALTH RELEVANCE. Females who participate in cutting and landing sports like soccer and basketball suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Our previous work shows that lateral knee load and trunk motion can each independently increase ACL injury risk in female athletes. The major objectives of this proposal are to determine how lateral trunk motion increases knee load in female athletes who are at greater risk ACL injury and to develop exercise training programs that decrease trunk motion, knee load and ACL injury risk in these high-risk athletes.

描述（由申请人提供）：参加切割和着陆运动的女性前交叉韧带（ACL）损伤的发生率是参加相同高风险运动的男性的2至10倍。50%到100%的前交叉韧带受伤的女性在受伤后的10到20年内会患上膝关节骨关节炎。外膝关节外旋力矩（LOAD）预测女运动员ACL损伤具有较高的敏感性和特异性。控制侧干运动（LTM）也可以预测前交叉韧带损伤，在女性运动员中具有相似的敏感性和特异性。这些预测因素可能是相互关联的，因为躯干的侧位可以通过生物力学和神经肌肉机制诱导膝关节外展负荷。女性前交叉韧带损伤的机制通常包括高膝关节负荷和高LTM，大部分体重转移到受伤肢体，足部位于身体重心外侧。意想不到的扰动也常常是损伤机制的一个因素。LTM可能通过侧位和增加GRF矢量（GRFv）的大小或改变髋关节反应性内收力矩（HAdT）导致膝关节负荷增加。我们的长期目标是确定增加女性运动员ACL损伤风险的机制，并开发专门针对这些机制的神经肌肉训练（NMT）干预措施。如果本提案的目标得以实现，将开发一种基于证据的NMT干预措施，并在全国范围内提供，这将有效地降低高危女运动员ACL损伤的风险。本提案的主要目的是确定LTM的增加是否会改变女运动员的负荷。本研究将验证LTM增加膝关节负荷的中心假设，以及旨在增加躯干运动的冠状面控制的NMT将降低女性的负荷。目的1旨在确定躯干运动可能增加女性运动员膝关节负荷的机制。将检查躯干冠状面控制（LTM）与GRFv、HAdT和膝关节负荷的关系。我们将通过生物力学（增加GRFv）和/或神经肌肉（增加相对HAdT）机制确定LTM增加是否会增加膝关节负荷。Aim 1的中心假设是，增加的LTM会通过增加GRFv、增加HAdT或在切割和着陆过程中通过这些机制的组合来增加女性运动员的膝关节负荷。我们假设没有这两种机制的女性膝关节负荷较低，GRFv或HAdT升高的女性膝关节负荷中等，而GRFv和HAdT升高的女性膝关节负荷较高。目的2是在一项随机对照试验（RCT）中，确定以减少冠状面躯干运动（TNMT）为目标的NMT是否会比假/对照训练更大程度地减少LTM和膝关节负荷。Aim 2的主要假设是TNMT会降低LTM和膝关节负荷。次要假设将使用事后分析来检验LTM、GRFv、HAdT和LOAD变化与TNMT之间的关系。针对女运动员前交叉韧带负荷机制的神经肌肉干预。公共卫生相关性。参加像足球和篮球这样的切割和着陆运动的女性遭受前交叉韧带（ACL）损伤的几率是参加同样高风险运动的男性的2到10倍。我们之前的研究表明，侧膝负荷和躯干运动都可以独立地增加女性运动员ACL损伤的风险。本提案的主要目的是确定躯干侧向运动如何增加前交叉韧带损伤风险较大的女运动员的膝关节负荷，并制定运动训练计划，减少这些高危运动员的躯干运动、膝关节负荷和前交叉韧带损伤风险。