Quadriceps inhibition after ACL injury: Neuromuscular and functional consequences

描述（由申请人提供）：本申请的基本原理是允许Riann Palmieri-Smith博士接受必要的教学培训和实践研究经验，使其成为独立的临床研究科学家。该奖项将为她提供一个机会，完成生物力学和临床研究设计领域的课程。Palmieri-Smith博士将在Ashton-Miller博士、Sowers博士和Wojtys博士的指导下进行临床研究，检查股四头肌抑制对膝关节力学的影响，还将检查引入神经肌肉电刺激（NMES）作为ACL康复辅助手段的可行性。在此奖项期间收集的经验的基础上，Palmieri-Smith博士将使用她从机械，实验室研究中获得的信息来开发和测试临床干预措施，这些干预措施可以改善创伤性膝关节损伤和骨关节炎患者的神经肌肉和功能恢复。拟议的研究将确定导致生物力学，功能和神经肌肉适应所需的股四头肌抑制的程度，以及在ACL重建后康复中引入NMES（一种能够恢复股四头肌激活的干预措施）以恢复正常力学的可行性。爆发叠加技术将用于ACL重建患者子集，以估计ACL重建之前和之后以及NMES之前和之后的四头肌抑制。力学将在一个单腿向前跳检查。相关性：ACL损伤和重建后存在股四头肌抑制，并且在修复后通常持续数年，其后果仍然难以捉摸。我们的工作将有助于更好地了解肌肉功能障碍如何影响关节保护机制。将NMES作为ACL康复的辅助手段，可促进股四头肌激活的持续改善，从而恢复下肢力学，并可能降低创伤后骨关节炎的发生率。这些知识将帮助临床医生设计适当的康复方案，并返回到发挥指导方针，将防止未来的损伤和关节退化。

DESCRIPTION (provided by applicant): The rationale for this application is to allow Dr. Riann Palmieri-Smith to receive both the didactic training and practical research experience necessary for her evolution into an independent clinical research scientist. This award will provide her with an opportunity to complete coursework in the areas of biomechanics and clinical research design. Dr. Palmieri-Smith will conduct clinical research, under the direction of Drs. Ashton-Miller, Sowers, and Wojtys examining the impact of quadriceps inhibition on knee mechanics and will also examine the feasibility of introducing neuromuscular electrical stimulation (NMES) as an adjunct to ACL rehabilitation. Building on the experience gathered during the period of this award, Dr. Palmieri-Smith will use the information she obtains from mechanistic, laboratory-based studies to develop and test clinical interventions that can improve the neuromuscular and functional recovery of persons following traumatic knee joint injury and those with osteoarthritis. The proposed research will determine the magnitude of quadriceps inhibition necessary to result in biomechanical, functional, and neuromuscular adaptations, and the feasibility of introducing NMES, an intervention capable of restoring quadriceps activation, in rehabilitation post-ACL reconstruction to restore normal mechanics. The burst superimposition technique will be utilized in subsets of ACL reconstructed patients to estimate quadriceps inhibition prior to and following ACL reconstruction and prior to and following NMES. Mechanics will be examined during a onelegged forward hop. RELEVANCE: Quadriceps inhibition is present following ACL injury and reconstruction and often persists for years following repair and its consequences remain elusive. Our work will allow for a better understanding of how muscle dysfunction impacts joint protective mechanisms. Introducing NMES as an adjunct to ACL rehabilitation may promote sustained improvements in quadriceps activation thereby restoring lower extremity mechanics and potentially reducing the incidence of post-traumatic osteoarthritis. This knowledge will aid clinicians in designing appropriate rehabilitation protocols and return to play guidelines that will prevent future injury and joint degeneration.