ACL Reconstruction in the Female Athlete: Strength, Knee Mechanics and Outcome

描述(申请人提供)：骨关节炎(OA)是最常见的关节疾病之一，通常会导致严重的残疾。尽管发病率很高，但对于骨性关节炎的发病机制却知之甚少，尽管细胞和生物力学机制都有牵连。膝关节骨性关节炎通常发生在前交叉韧带(ACL)损伤后，尽管进行了手术重建，尤其是在女性。在女性运动员中，前交叉韧带损伤的高发生率，以及未来关节损伤的高风险，促使人们对这一人群中膝骨性关节炎发生的潜在机制进行研究。股四头肌力量缺陷在前交叉韧带重建后很常见，并在结构化康复和患者恢复高水平活动后持续很长时间。股四头肌无力与关节力学改变有关，这可能会传播关节软骨损伤。关于在高水平活动中股四头肌力量受损对关节力学的影响或对纵向临床结果的影响，我们知之甚少。推测如果重建前交叉韧带的运动员重返高水平活动，并将膝关节暴露在没有正常股四头肌力量和关节力学的实质性力量中，关节软骨损伤的条件可能会被启动和传播。前交叉韧带重建后安全回归高水平体育活动的适当指南尚不清楚。在前交叉韧带损伤患者中，女性运动员是一个独特的亚群，一些独特的特征表明，她们对前交叉韧带损伤和前交叉韧带重建的反应可能不同于男性。这项建议的具体目标包括仔细、纵向地检查残余股四头肌力量缺陷对膝关节力学和前交叉韧带重建女运动员功能结果的影响。这项研究是对前交叉韧带重建术后女运动员的全面调查，将作为建立安全和适当的康复指南的必要步骤。膝骨性关节炎是一种进行性关节疾病，通常会导致严重的疼痛和残疾。尽管重建了前交叉韧带，但前交叉韧带损伤的个体仍有发生膝骨性关节炎的巨大风险。这项研究将提供有关前交叉韧带损伤和重建后关节炎关节改变的潜在机制的有价值的信息。这项研究的信息将作为未来研究特定干预措施的跳板，这些干预措施可能会降低女性运动员前交叉韧带损伤后关节炎性改变的风险。

DESCRIPTION (provided by applicant): Osteoarthritis (OA) is one of the most prevalent joint disorders that often leads to severe disability. Despite the incidence, relatively little is known regarding the pathogenesis of OA although both cellular and biomechanical mechanisms are implicated. Knee OA commonly develops following anterior cruciate ligament (ACL) injury despite surgical reconstruction, particularly in females. The high incidence of ACL injuries in female athletes, combined with the high risk for future joint damage, motivates investigation of mechanisms underlying the development of knee OA in this population. Quadriceps strength deficits are common following ACL reconstruction and persist long after structured rehabilitation and after patients have returned to high-level activities. Quadriceps muscle weakness is associated with altered joint mechanics that may propagate articular cartilage damage. Little information is known regarding the impact of impaired quadriceps strength on joint mechanics during high-level activities or on longitudinal clinical outcomes. It is suspected that if athletes with ACL reconstruction return to high-level activities and expose their knee to substantial forces without normalized quadriceps strength and joint mechanics, the conditions for articular cartilage damage may be initiated and propagated. Appropriate guidelines for safe return to high-level sport activities following ACL reconstruction are not known. Female athletes are a unique subpopulation within those with ACL injury, and several unique characteristics suggest that they may respond to ACL injury and ACL reconstruction differently than males. The Specific Aims of this proposal involve careful, longitudinal examination of the impact of residual quadriceps strength deficits on knee joint mechanics and on functional outcomes in female athletes with ACL reconstruction. This study represents a comprehensive investigation of female athletes following ACL reconstruction and will serve as a necessary step in establishing safe and appropriate rehabilitation guidelines. Knee OA is a progressive joint disease that often leads to severe pain and disability. Individuals with ACL injury have substantial risk of developing knee OA despite ACL reconstruction. This investigation will provide valuable information regarding potential mechanisms involved in the initiation of arthritic joint changes following ACL injury and reconstruction. Information from this study will serve as springboard for future research of specific interventions that may reduce the risk of arthritic joint changes following ACL injury in female athletes.