New potential to restore neuromuscular and joint function after ACL injury

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The project objective is to determine whether the novel bridge-enhanced anterior cruciate ligament restoration (BEAR) procedure restores biomechanical knee function compared to the standard of care anterior cruciate ligament reconstruction (ACLR), leading to improved patient outcomes after ACL injury. The BEAR procedure differs from ACLR as it uses a scaffold to promote healing of the injured ACL whereas ACLR requires removal of the entire ligament, which severs and then removes neural structures within the native ACL. Clinical studies of BEAR have shown that muscle strength is restored following BEAR but not after ACLR, even at 2 years. BEAR patients also reported superior sports-related quality of life earlier in their recovery. We postulate that these differences are due to the preservation of neural activity and neuromuscular feedback with BEAR. Therefore, our overarching hypothesis is that BEAR preserves the neuromuscular activation patterns about the knee that, in turn, promote normal hop landing joint motion and corresponding patient-reported outcomes compared to ACLR. Three aims are addressed: 1) to use our novel machine learning approach to classify neuromuscular activity patterns as belonging to ACLR, BEAR or healthy control subjects (Controls); 2) to compare the tibiofemoral positions of the knee between ACLR, BEAR, and Controls at ground contact when landing from a 1-leg hop; and 3) to examine the correlation between functional measures and KOOS sports-related patient-reported reported outcomes. Twenty-six subjects enrolled in a parent randomized clinical trial at Rhode Island Hospital (BEAR-MOON) will be enrolled in the proposed study at their 2-year follow-up visit. An age- and sex-matched control group will also be recruited from the community. All 39 subjects will perform a 1-leg hop-for-distance activity while surface electromyography is recorded to assess neuromuscular function (Aim 1), and biplane videoradiography will be performed to evaluate precise tibiofemoral motion (Aim 2). Relationships between patient-reported and biomechanical outcome measures will be tested using regression analyses (Aim 3). If the hypotheses of the proposed study are supported, the results will demonstrate that neurophysiological mechanisms underlying BEAR recovery are fundamentally different from ACLR and that they have a significant impact on patient sports-related quality of life not currently addressed by conventional ACL injury treatments.