ACL injury mechanisms & offaxis neuromuscular diagnosis & training

ACL损伤机制

• 批准号: 7736012
• 负责人: Li-Qun Zhang
• 金额: $ 37.11万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7736012
• 关键词: 3-Dimensional; Anterior Cruciate Ligament; Clinical; Control Groups; Custom; Data; Devices; Diagnosis; Diagnostic; Educational Intervention; Evaluation; Exercise; Female; Goals; Incidence; Individual; Intervention; Joint Laxity; Knee; Lateral; Leg; Ligaments; Lower Extremity; Measurement; Measures; Modeling; Motion; Movement; Neuromechanical Changes; Neuromechanics; Outcome Measure; Participant; Performance; Positioning Attribute; Predisposition; Property; Proprioception; Reaction Time; Research; Research Design; Risk; Rotation; Schools; Sex Characteristics; Simulate; Slide; Sports; Stress; Time; Torque; Training; Woman; Youth; base; foot; high school; improved; injured; interest; intervention program; ligament injury; male; men; muscle strength; neuromuscular; notch protein; novel; pressure; public health relevance; tool

DESCRIPTION (provided by applicant): ACL is the most commonly injured knee ligament in sports-related activities, especially in pivoting sports. ACL injury mechanisms, including factors contributing to the 2-9 times higher incident rate in female athletes than their male counterparts, are still not very clear. Considering off-axis knee motions (tibial rotation and valgus/varus) are rather limited and there may be gender differences in off-axis properties, ACL injuries are often associated with excessive off-axis loadings. Objectives: To investigate off-axis neuromechanical and anatomical properties of noncontact ACL injuries in men and women, and to conduct intervention training based on the diagnosis to improve neuromuscular control of risky, potentially injurious off-axis movements. Hypothesis 1: Females have lower stability, stiffness and strength, greater joint laxity, and less sensitive proprioception in external and internal tibial rotations and in valgus and varus than males. Specific Aim 1: To perform a pre-training diagnosis of knee off-axis neuromechanical properties in females and males using custom knee devices for off-axis evaluations and a novel pivoting-sliding elliptical machine. Clinical/functional measures will also be conducted. Hypothesis 2: Females are more likely to have ACL impingement than males under external tibial rotation and valgus loading, characterized by a subject-specific FE impingement modeling. Specific Aim 2: To determine the susceptibility of ACL impingement against the lateral notch wall during external tibial rotation and valgus in individuals using a 3-D FE ACL-impingement model. Hypothesis 3: Subject-specific training on a pivoting-sliding elliptical exercise machine based on the diagnosis improves off-axis neuromuscular control. Specific Aim 3: To conduct subject-specific pivoting-sliding elliptical training and improve off-axis neuromuscular control, based on the pre-training diagnosis. Specific Aim 4: To determine training-induced neuromechanical and functional changes. Study Design Setting: Off-axis neuromechanical properties will be determined for individual subjects. An intervention program will be conducted accordingly. Setting: A research lab for neuromechanical evaluations, and school gym for training/evaluation. Participants: 60 female and 60 male athletes from local high school and youth sports teams. Interventions: Training off-axis neuromuscular control using a novel pivoting-sliding elliptical machine. Training will be done in three 40-minute training session per week for 6 weeks. Outcome Measures: Stability, muscle strength, stiffness, laxity, proprioception, and reaction time in tibial rotation (pivoting) and in valgus/varus, functional activities, and incidence of ACL injuries. PUBLIC HEALTH RELEVANCE: The proposed studies will conduct subject-specific diagnosis on off-axis neuromechanical properties in internal and external rotations and in valgus/varus in individual female and male subjects, and perform subject-specific intervention training of off-axis neuromuscular control based on the diagnosis, using a novel pivoting-sliding elliptical machine.

描述（由申请人提供）：ACL 是运动相关活动中最常受伤的膝关节韧带，尤其是旋转运动中。 ACL 损伤机制，包括导致女运动员发生率比男运动员高 2-9 倍的因素，目前尚不十分清楚。考虑到膝关节离轴运动（胫骨旋转和外翻/内翻）相当有限，并且离轴特性可能存在性别差异，ACL 损伤通常与过度的离轴载荷有关。目的：调查男性和女性非接触性 ACL 损伤的离轴神经力学和解剖学特性，并根据诊断进行干预训练，以改善对危险、潜在伤害性离轴运动的神经肌肉控制。假设1：与男性相比，女性的稳定性、刚度和力量较低，关节松弛度较大，胫骨外旋、内旋、外翻和内翻的本体感觉较不敏感。具体目标 1：使用用于离轴评估的定制膝关节设备和新型旋转滑动椭圆机，对女性和男性的膝关节离轴神经力学特性进行训练前诊断。还将进行临床/功能测量。假设 2：在胫骨外旋和外翻负荷下，女性比男性更容易发生 ACL 撞击，其特征是特定于受试者的 FE 撞击模型。具体目标 2：使用 3-D FE ACL 撞击模型确定个体在胫骨外旋和外翻过程中 ACL 撞击外侧切迹壁的敏感性。假设 3：基于诊断在旋转滑动椭圆运动机上进行针对特定主题的训练可改善离轴神经肌肉控制。具体目标3：根据训练前的诊断，进行针对特定科目的旋转滑动椭圆训练并提高离轴神经肌肉控制。具体目标 4：确定训练引起的神经机械和功能变化。研究设计设置：将针对个体受试者确定离轴神经力学特性。将相应地实施干预计划。环境：用于神经力学评估的研究实验室和用于培训/评估的学校体育馆。参与者：来自当地高中和青少年运动队的 60 名女运动员和 60 名男运动员。干预措施：使用新型旋转滑动椭圆机训练离轴神经肌肉控制。培训将每周进行 3 次，每次 40 分钟，持续 6 周。结果测量：稳定性、肌肉力量、僵硬、松弛、本体感觉、胫骨旋转（旋转）和外翻/内翻的反应时间、功能活动和 ACL 损伤的发生率。 公共健康相关性：拟议的研究将对个别女性和男性受试者的内旋和外旋以及外翻/内翻的离轴神经力学特性进行特定于受试者的诊断，并根据诊断结果，使用新型旋转滑动椭圆机进行离轴神经肌肉控制的特定受试者干预训练。