OSTEOBLAST AND ADIPOCYTE DIFFERENTIATION BY FOSB

前交叉韧带（ACL）损伤是普遍的，经常导致不稳定，股四头肌无力和骨关节炎。（OA）许多慢性前交叉韧带缺乏症患者在前交叉韧带破裂数年后仍有膝关节OA的迹象。那些不能很好地代偿前交叉韧带缺陷（非铜）的患者所经历的虚弱和不稳定，会导致代偿策略沉淀或恶化膝关节OA。这些不良的代偿策略在手术重建后并不能统一解决，并且那些接受重建的患者也增加了患膝关节OA的风险。本研究的总体目标是确定动态稳定膝关节的有效康复方案是否能减少导致膝关节炎高风险人群发生骨关节炎的适应性。80名预定进行手术的前交叉韧带破裂患者将被随机分配到一组，其中包括一种称为扰动训练的神经肌肉训练形式，或者是标准组。他们将在手术前后通过运动分析和x线摄影进行评估。体内测量的运动学、动力学、胫骨平移和基于肌电图的关节压缩模型将用于比较。该随机试验旨在证明，在术前康复（包括扰动训练）后，非铜患者采用的运动模式：1)改善关节稳定性和减少肌肉收缩，2)重建后持续存在，3)重建后功能结果更好，4)随着时间的推移，与标准术前治疗策略相比，膝关节疼痛和OA的发展更少。从这个项目中获得的信息将为每年大约10万美国人acl破裂并接受重建手术的管理提供有价值的见解。更重要的是，如果摄动训练方案能够诱导膝关节动态稳定，从而真正起到关节保护的作用，那么将其应用于其他有患膝关节OA风险的患者，可能有助于减少这种致残性临床疾病的发生率。

Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Many of those with chronic ACL deficiency have evidence of knee OA years after ACL rupture. Weakness and instability experienced by those who do not compensate well for ACL deficiency (non-copers) independently lead to compensation strategies that could precipitate or worsen knee OA. These poor compensation strategies do not uniformly resolve after surgical reconstruction and those who undergo reconstruction also have an increased risk of developing knee OA. The overall goal of this work is to determine whether effective rehabilitation programs to dynamically stabilize the knee reduce the adaptations that lead to osteoarthritis in a population at great risk for the development of knee OA. Eighty individuals with ACL rupture who are scheduled for surgery will be randomly assigned to a group that includes a form of neuromuscular training called perturbation training, or a standard group. They will be evaluated before and after surgery using motion analysis and radiography. In vivo measures of kinematics, kinetics, tibial translation and EMG based models of joint compression will be used for comparison. This randomized trial is designed to demonstrate that, after preoperative rehabilitation that includes perturbation training, movement patterns adopted by non-copers: 1) demonstrate improve joint stability and reduced muscle cocontraction, 2) persist after reconstruction and 3) result in better functional outcomes after reconstruction and 4) lead to the development of less knee pain and OA over time than standard preoperative treatment strategies. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACLs each year and undergo reconstructive surgery. More importantly, if the perturbation training program's ability to induce dynamic knee stability actually results in joint protection, its application to others at risk for the development knee OA may help reduce the incidence of this disabling clinical condition.