OSTEOBLAST AND ADIPOCYTE DIFFERENTIATION BY FOSB

前交叉韧带（ACL）损伤是一种常见的损伤，常导致关节不稳定、股四头肌无力和骨关节炎。 (OA)许多患有慢性ACL缺陷的患者在ACL断裂后数年出现膝关节OA的证据。 那些不能很好地补偿ACL缺陷的患者（非copers）所经历的虚弱和不稳定独立地导致可能加速或恶化膝关节OA的补偿策略。 这些不良的补偿策略在手术重建后并不一致，并且接受重建的患者发生膝关节OA的风险也增加。 这项工作的总体目标是确定是否有效的康复计划，以动态稳定膝关节减少适应，导致骨关节炎的人群在发展为膝关节骨性关节炎的风险很大。 将80名计划进行手术的ACL断裂患者随机分配到一组，该组包括一种称为扰动训练的神经肌肉训练形式，或标准组。 将在手术前后使用运动分析和X线摄影对其进行评价。 将使用运动学、动力学、胫骨平移和基于EMG的关节压缩模型的体内测量进行比较。 这项随机试验旨在证明，在术前康复（包括扰动训练）后，非手术患者采用的运动模式：1）证明关节稳定性改善，肌肉共收缩减少，2）重建后持续存在，3）重建后功能结局更好，4）与标准术前治疗策略相比，随着时间的推移，膝关节疼痛和OA的发生率更低。 来自该项目的信息将为每年约10万名美国人的乳房破裂和接受重建手术的管理提供有价值的见解。 更重要的是，如果扰动训练计划诱导动态膝关节稳定性的能力实际上导致关节保护，则将其应用于其他有膝关节OA发展风险的人可能有助于降低这种致残性临床状况的发生率。

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.