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

在过去的六年里，我的多学科受训者团队开发了新的方法，以改善健康成人人群中膝关节运动学，神经肌肉控制和负荷相关研究的测量和应用。这导致了一个完全资助的客座教授（哥本哈根大学）和超过50个演讲，26个出版物（包括编辑精选），5个提交的手稿，3个提名论文，以及获奖的3D打印膝盖支架。 我的研究计划的下一阶段主要集中在儿科人群，部分原因是在功能要求高的任务中缺乏围绕其神经肌肉控制策略的研究，部分原因是青春期早期人群中膝关节损伤的显着和持续上升。对于背景，多达1/20的年轻竞技篮球或足球运动员每年暴露都会遭受严重的膝关节损伤，但在正常发育人群中，对性别和发育激活和运动策略没有达成共识，并且儿科膝关节损伤机制定义不清。此外，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现有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，调查性别和青春期对膝关节神经肌肉控制，负荷和稳定性的影响，通过青春期。我们将评估T1（11/12岁）至T2（13/14岁）的160名年轻健康男性和女性，目的如下： (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，包括希望任务期间的时空测量，力量，肌肉耐力，神经肌肉控制和着陆任务期间的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：我们将开发一种新型的、可扩展的基于MRI的神经肌肉骨骼模型，以对比T1和T2的儿科关节和韧带力。 (3)识别青春期前和青春期早期男性和女性的膝关节控制策略：我们将使用主成分和线性判别分析的组合，对汇总的Aim 1和2数据提取变量，预测着陆任务期间的最佳或失败的膝关节控制策略。 我的学员将获得运动分析，数据科学和建模方面的可转移技能，同时与来自我们社区的多元化年轻人合作。我们将深入了解日益脆弱的人群中潜在的性别差异和损伤机制。我的长期目标是表征青春期功能能力、神经肌肉控制和膝关节稳定性的演变，这将通过本申请之外的第三次评价（15/16岁）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.