Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female 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）损伤的发生率比参加相同高风险运动的男性高2至10倍。50%到100%的ACL受伤的女性在受伤后的一到二十年内会患上受伤膝盖的骨关节炎。膝关节外展力矩（LOAD）预测女性运动员ACL损伤具有较高的敏感性和特异性。躯干外侧运动（LTM）的控制也预测ACL损伤的敏感性和特异性水平相似的女性运动员。这些预测因素可能是相关的，因为躯干的侧向定位可以通过生物力学和神经肌肉机制引起膝关节外展负荷。女性ACL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上，足部位于身体质心的外侧。一个意外的扰动也往往是一个贡献者的伤害机制。LTM可能通过外侧定位和GRF向量（GRFv）幅度增加或通过改变反作用髋内收肌扭矩（HAdT）导致膝关节载荷增加。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。如果该提案的目标得以实现，将在全国范围内开发并提供基于证据的NMT干预措施，以有效和高效地降低高风险女运动员的ACL损伤风险。该提案的主要目标是确定是否增加LTM改变女性运动员的负荷。本应用程序将测试中心假设，即LTM增加膝关节负荷，NMT旨在增加躯干运动的冠状面控制，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。将相对于GRFv、HAdT和膝关节载荷检查躯干（LTM）的冠状面控制。我们将确定LTM增加是否通过生物力学（GRFv增加）和/或神经肌肉（相对HAdT增加）机制增加膝关节载荷。目标1的中心假设是，通过增加GRFv、增加HAdT或通过这些机制的组合，在切割和着陆期间，增加LTM将增加女性运动员的膝关节负荷。我们假设，没有任何机制的女性将有较低的膝关节负荷，GRFv或HAdT增加的女性将有中度负荷，GRFv和HAdT增加的女性将有较高的膝关节负荷。目的2旨在确定在随机对照试验（RCT）中，与假手术/对照训练相比，旨在减少冠状面躯干运动（TNMT）的NMT是否会更大程度地降低LTM和膝关节载荷。目标2的主要假设是TNMT将降低LTM和膝关节载荷。次要假设将使用事后分析检验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。 参加足球和篮球等切割和着陆运动的女性遭受前交叉韧带（ACL）损伤的几率比参加相同高风险运动的男性高2至10倍。我们以前的工作表明，外侧膝关节负荷和躯干运动可以各自独立地增加女性运动员ACL损伤的风险。本提案的主要目标是确定躯干侧向运动如何增加ACL损伤风险较大的女性运动员的膝关节负荷，并制定运动训练计划，减少这些高风险运动员的躯干运动，膝关节负荷和ACL损伤风险。

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.