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让 Riann Palmieri-Smith 博士接受必要的教学培训和实践研究经验，以使其成为一名独立的临床研究科学家。该奖项将为她提供完成生物力学和临床研究设计领域课程的机会。 Palmieri-Smith 博士将在 Drs. 的指导下进行临床研究。 Ashton-Miller、Sowers 和 Wojtys 研究了股四头肌抑制对膝关节力学的影响，还将研究引入神经肌肉电刺激 (NMES) 作为 ACL 康复辅助手段的可行性。根据获奖期间积累的经验，帕尔米耶里-史密斯博士将利用她从机械、实验室研究中获得的信息来开发和测试临床干预措施，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。突发叠加技术将用于 ACL 重建患者的子集，以估计 ACL 重建之前和之后以及 NMES 之前和之后的股四头肌抑制。将在单腿向前跳跃期间检查力学。相关性：股四头肌抑制在 ACL 损伤和重建后出现，并且通常在修复后持续数年，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。引入 NMES 作为 ACL 康复的辅助手段可以促进股四头肌激活的持续改善，从而恢复下肢力学并有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和重返比赛指南，以防止未来受伤和关节退化。

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.