Prognostic Study of the Risk Factors for Contralateral ACL Injury

项目摘要 前十字韧带（ACL）损伤严重，每年影响超过120，000人 在美国和全世界140万人。据估计，其中三分之一的人将 对侧膝关节或ACL移植物随后遭受同类损伤。这些伤不仅 导致运动和活动时间损失，立即致残，通常需要手术， 与膝关节创伤后骨关节炎（PTOA）相关， 选择了ACL损伤和PTOA的后续后遗症由于其较早发作而使人衰弱， 特发性骨关节炎（OA），造成了相当大的治疗问题，因为大多数这些损伤 发生在15至25岁之间的活跃的年轻人中，这些年轻人对他们的关节有很高的要求， 因此需要更早和更频繁的手术和康复。 在之前的资助期间，我们确定了首次ACL撕裂的风险因素（请参见进展 报告详情）。该研究中的一部分受伤运动员在接受手术、康复治疗后接受了随访。 并恢复运动2年，18%的人继续遭受对侧ACL的完全破坏 （CACL），10.9%发生移植物损伤（总再损伤率为28.9%）。与其治疗这种创伤 通过手术方法进行PTOA的后续负担，仅略微成功， 积极主动的方法是识别ACL损伤风险增加的个体， 预防计划，以减轻这种风险。本申请中的调查重点是建立一个 全面了解CACL损伤的风险因素。这是理解的关键步骤 发生这些损伤的原因，制定预防策略，将ACL损伤考虑在内，以及 用于识别那些最有可能遭受反复ACL创伤的患者， 伤害预防干预。 本研究的目标是确定与下列因素相关的一系列综合风险因素： 在首次ACL损伤恢复并恢复运动/活动后患有CACL。这将是 通过执行以下具体目标来实现： 1.前瞻性地识别和招募首次遭受ACL损伤的高中和大学运动员。 2.在治疗时测量一组综合的随后CACL损伤的潜在风险因素， 运动员在治疗和康复后重返运动/活动。这些将包括解剖，力量和 对侧腿的神经肌肉测量，以及临床、人口统计学和环境因素。 3.随时间推移随访研究受试者，以确定随后对CACL的非接触性损伤。 4.确定与CACL损伤风险相关的风险因素组合， 男性和女性。

Project Summary Injuries to the anterior cruciate ligament (ACL) are highly debilitating; each year they affect more than 120,000 individuals in the United States and 1.4 million worldwide. It is estimated that one-third of these individuals will suffer subsequent truama of the same kind to the contralateral knee or ACL graft. Not only do these injuries result in time lost from sport and activity, are immediatley disabeling, and typically require surgery, they are associated with post traumatic osteoarthritis (PTOA) of the knee regardless of the type of treatment that is chosen. ACL injury and the subsequent sequela of PTOA is debilitating due to its earlier onset in comparison to idiopathic osteoarthritis (OA), creating a considerable therapeutic concern as a majority of these injuries occur in active young individuals between 15 and 25 years of age that place high demand on their joints and consequently require earlier and more frequent surgery and rehabilitation. During the prior funding interval, we determined the risk factors for a first time ACL tear (please see Progress Report for details). A subset of the injured athletes from that study were followed after surgery, rehabilitation and return to sport for 2 years, and 18% went on to suffer a complete disruption of their contralateral ACL (CACL), and 10.9% suffered a graft injury (total re-injury rate of 28.9%). Rather than treat this trauma and the subsequent burden of PTOA though surgical approaches, which are only marginally successful, a more proactive approach is to identify individuals at increased risk of suffering ACL injury and develop injury prevention programs to mitigate that risk. The investigation in this application is focused on establishing a complete understanding of the risk factors for a CACL injury. This is an essential next step for understanding why these injuries occur, the development of prevention strategies that take prior ACL injury into account, and for identifying those that are at the greatest risk of suffering repeated ACL trauma so they can be targeted for injury prevention interventions. The goal of this investigation will be to determine the comprehensive set of risk factors associated with suffering a CACL following recovery form a first time ACL injury and return to sport/activity. This will be accomplished by executing the following Specific Aims: 1. To prospectively identify and recruit high school and college athletes who suffer a first-time ACL injury. 2. To measure a comprehensive set of potential risk factors for subsequent CACL injury at the time of the athlete's return to sport/activity following treatment and rehabilitation. These will include anatomic, strength and neuromuscular measurements on the contralateral leg, and clinical, demographic, and environmental factors. 3. To follow study subjects over time to identify subsequent non-contact injury to the CACL. 4. To determine combinations of risk factors that are associated with the risk of suffering a CACL injury in males and females.