Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes

描述(申请人提供)：参加划船和落地运动的女性遭受前十字韧带(ACL)损伤的几率是参加相同高危运动的男性的2至10倍。50%到100%的前交叉韧带损伤女性在受伤后一到二十年内会患上受伤膝关节的骨性关节炎。膝关节外展力矩(载荷)对预测女性运动员前交叉韧带损伤具有较高的敏感性和特异性。控制躯干侧方运动(LTM)对女性运动员前交叉韧带损伤的预测具有相似的敏感性和特异性。这些预测因素可能是相互关联的，因为躯干的侧向位置可以通过生物力学和神经肌肉机制来诱导膝关节外展负荷。女性前交叉韧带损伤的机制最常见的是高膝关节负荷和高LTM，大部分体重移到受伤的肢体上，脚位于身体质心的外侧。意想不到的干扰也常常是造成损伤机制的原因之一。LTM可能通过外侧定位和GRF向量(GRFv)或通过改变反应性髋内收肌扭矩(HADT)而导致膝关节负荷增加。我们的长期目标是确定增加女性运动员前交叉韧带损伤风险的机制，并开发针对这些机制的神经肌肉训练(NMT)干预措施。如果这项建议的目标得以实现，将开发一种基于证据的NMT干预措施，并在全国范围内提供，这将有效和高效地降低高危女运动员的前交叉韧带损伤风险。这项建议的主要目标是确定增加的LTM是否会改变女运动员的负荷。这项应用将检验LTM增加膝关节负荷以及旨在增加对躯干运动的冠状平面控制的NMT将减少女性负荷的中心假设。目的1旨在确定躯干运动可能增加女运动员膝关节负荷的机制。躯干的冠状面控制(LTM)将根据GRFv、HADT和膝关节负荷进行检查。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)机制增加膝关节负荷。目标1的中心假设是，增加的LTM将通过增加GRFv、通过增加HADT或通过这些机制的组合来增加女运动员在切割和着陆时的膝关节负荷。我们假设，没有这两种机制的女性膝关节负荷较低，GRFv或HADT增加的女性膝关节负荷中等，GRFv和HADT增加的女性膝关节负荷高。目的2在一项随机对照试验(RCT)中，确定以减少冠状平面躯干运动(TNMT)为目标的NMT是否会比假/对照训练更大程度地降低LTM和膝关节负荷。目标2的主要假设是，TNMT将减少LTM和膝关节负荷。第二个假设将使用后随机分析来检验LTM、GRFv、HADT的变化与TNMT负荷之间的关系。针对女运动员前交叉韧带负荷机制的神经肌肉干预。与公共卫生相关。参加足球和篮球等切割和着陆运动的女性前十字韧带(ACL)损伤的发生率是参加相同高危运动的男性的2到10倍。我们以前的工作表明，膝关节侧向负荷和躯干运动各自独立地增加了女运动员前交叉韧带损伤的风险。这项建议的主要目标是确定侧向躯干运动如何增加有较高前交叉韧带损伤风险的女运动员的膝关节负荷，并制定运动训练计划，以降低这些高危运动员的躯干运动、膝关节负荷和前交叉韧带损伤风险。

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.