THE INFLUENCE OF SEX AND PUBERTY ON KNEE JOINT NEUROMUSCULAR CONTROL, LOADING AND STABILISATION

在过去的六年里，我的多学科受训团队开发了新的方法，以改进与膝关节运动学、神经肌肉控制和负荷相关的研究在健康成年人群中的测量和应用。这导致了一个全额资助的访问教授职位(哥本哈根大学)和超过50个演讲，26个出版物(包括一份编辑精选)，5个提交的手稿，3个获奖提名论文，以及一个获奖的3D打印膝盖支架。 我的下一阶段研究计划将重点放在儿科人群，部分原因是缺乏关于他们在执行高功能任务时的神经肌肉控制策略的研究，部分原因是青少年早期人群中膝关节损伤的显著和持续上升。作为背景，每20名年轻竞技篮球或足球运动员中就有1人在每年的暴露中遭受严重的膝部损伤，但对于正常发育人群中的性和发育激活和运动战略没有达成共识，儿科膝部损伤的机制也没有明确的定义。此外，现有的关于青春期和性别相关的神经肌肉控制和生物力学变化的文献来自横断面队列研究，限制了用于形成我们对发育变化的理解的证据水平(即不能假设因果关系)。因此，我提出了一个纵向计划，以调查性别和青春期对青春期期间膝关节神经肌肉控制、负荷和稳定性的影响。我们将评估160名年轻健康的男性和女性，年龄从T1(11/12岁)到T2(13/14岁)，目标如下： (1)描述青春期前和青春期早期男性和女性的功能能力：我们将测量功能能力，包括希望任务中的时空测量，着陆任务中的力量、肌肉耐力、神经肌肉控制和全身运动学和动力学。 (2)青春期前和青春期早期男性和女性的膝关节韧带和接触力模型：我们将开发一个新的、可扩展的基于MRI的神经肌肉骨骼模型，以对比T1和T2的儿科关节和韧带的力。 (3)确定青春期前和青春期早期男性和女性的膝关节控制策略：我们将对Aim1和Aim2数据进行主成分和线性判别分析的组合，以提取预测着陆任务中最佳或失败的膝关节控制策略的变量。 我的实习生将获得运动分析、数据科学和建模方面的可移植技能，同时与我们社区的不同年轻人一起工作。我们将对日益脆弱的人群中潜在的性别差异和伤害机制提供见解。我的长期目标是描述青春期功能能力、神经肌肉控制和膝关节稳定性的演变，在此应用之外的第三次评估(15/16岁)将实现。

Over the past six years, my multidisciplinary team of trainees has developed new methods to improve the measurement and application of research related to knee joint kinematics, neuromuscular control and loading in the healthy adult population. This has led to a fully funded Visiting Professorship (U of Copenhagen) and over 50 presentations, 26 publications (including an Editor's Pick), 5 submitted manuscripts, 3 prize nominated theses, and an award-winning 3D printed knee brace. This next phase of my research program focuses on the paediatric population, in part due to the lack of research surrounding their neuromuscular control strategies during functionally demanding tasks, and in part due to the significant and continuous rise of knee injuries in the early pubescent population. For context, as many as 1 in 20 young competitive basketball or soccer players will sustain a significant knee injury per year of exposure, yet there is no consensus on sex and developmental activation and movement strategies in the normally developing population and paediatric knee injury mechanisms are poorly defined. Furthermore, existing literature on puberty- and sex-related changes in neuromuscular control and biomechanics is derived from cross-sectional cohort studies, limiting the level of evidence used to form our understanding of developmental changes (i.e. cause and effect cannot be assumed). I therefore propose a longitudinal program to investigate the Influence of Sex and Puberty on Knee Joint Neuromuscular Control, Loading and Stabilisation through puberty. We will assess 160 young healthy males and females from T1 (age 11/12) to T2 (age 13/14) with the following aims: (1) Describe the functional capacity of pre- and early pubescent males and females: We will measure functional capacity including spatio-temporal measures during hoping tasks, strength, muscular endurance, neuromuscular control and whole body kinematics and kinetics during landing tasks. (2) Model knee ligament and contact forces in pre- and early pubescent males and females: We will develop a novel, scalable MRI-based neuromusculoskeletal model to contrast paediatric joint and ligament forces from T1 and T2. (3) Identify knee joint control strategies in pre- and early pubescent males and females: We will use a combination of principal component and linear discriminant analyses on the pooled Aim1 and 2 data to extract variables that predict optimal or failed knee joint control strategies during landing tasks. My trainees will gain transferable skills in movement analysis, data science and modeling while working with a diverse young population from our community. We will provide insights into potential sex differences and injury mechanisms in an increasingly vulnerable population. My long term goal of characterising the evolution of functional capacity, neuromuscular control and knee stabilisation through puberty will be achieved with a third evaluation (age 15/16) beyond this application.