Walking Mechanics, Early Osteoarthritis Development, and Neuromuscular Training after Traumatic Knee Injury

项目摘要/摘要 每年有数十万青少年和青壮年患有前交叉韧带(ACL) 受伤。这些损伤通常会导致膝关节健康状况不佳，包括在5-5岁内发展成膝骨性关节炎(OA) 在前交叉韧带受伤15年后，这些运动员还处于青壮年。膝盖骨关节炎是一种疼痛和 影响生活质量、功能和整体健康的衰弱状态。膝骨性关节炎的发展速度相似 在前交叉韧带损伤和手术后的胫股关节和髌股关节。查处风险 影响胫股和膝骨股骨骨关节炎发生的因素都很重要。胫股骨折的一个危险因素 在前交叉韧带术后6个月时，膝关节骨性关节炎属于步行机制，但步行步态对膝关节骨性关节炎的影响不明显。 未在前交叉韧带手术后早期进行研究。步行机制是否可以通过以下途径得到改善也是未知的 术后神经肌肉康复。申请者的长期职业目标是优化肌肉骨骼 和一般健康，通过调查和开发干预措施来延缓或防止两者的发展 原发和继发性骨性关节炎及其他肌肉骨骼病变。这项提案的总体目标是 目的：1)量化前交叉韧带术后行走力学与髌股关节早期体征的关系 2)确定术后神经肌肉训练对前交叉韧带术后步行力学的影响 做手术。中心假设是：1)行走机制将与早期的膝骨股骨性关节炎相关； 2)神经肌肉训练后步行力学得到改善。目标1将量化两者之间的关系 步行步态力学和髌股(滑车)软骨T2松弛时间(表示关节 前交叉韧带手术后6个月。目标2将确定一个专门的术后效果 神经肌肉训练方案对前交叉韧带术后运动员步行力学的影响。走动分析将会 在目标1手术后6个月、神经肌肉训练前后以及1和2 AIM 2手术后数年，两个AIM的数据将使用有效的肌肉骨骼模型进行分析 除了关节角度和力矩之外，还能提供肌肉和关节接触力的方法。量化 磁共振成像数据也将在AIM 1和T2松弛术后6个月收集 时间将被用来量化软骨健康状况。该项目的成果将促进康复科学和 膝关节骨性关节炎发展的临床评估及针对性康复策略 办公自动化发展的已知风险因素。这些发现将有助于改善肌肉骨骼的健康、功能和质量 生活的一部分。该方案还将为申请人提供进行高质量纵向指导的基础 康复中的干预性和观察性研究，撰写令人信服和有影响力的建议，采取 研究到最终结论，在同行评议的期刊上发表，并为职业生涯做准备 独立的临床医生兼科学家。

PROJECT SUMMARY/ABSTRACT Hundreds of thousands of adolescents and young adults each year sustain anterior cruciate ligament (ACL) injuries. These injuries often lead to poor knee health, including knee osteoarthritis (OA) that develops within 5- 15 years after the ACL injury when these athletes are still in young adulthood. Knee OA is a painful and debilitating condition that impacts quality of life, function, and overall health. Knee OA develops at similar rates in the tibiofemoral joint and the patellofemoral joint after ACL injury and surgery. Investigating and treating risk factors for both tibiofemoral and patellofemoral OA development is important. One risk factor for tibiofemoral OA is walking mechanics 6 months after ACL surgery, but the effect of walking gait on patellofemoral OA has not been studied early after ACL surgery. It is also unknown if walking mechanics may be improved through neuromuscular rehabilitation after surgery. The applicant’s long-term career goal is to optimize musculoskeletal and general health by investigating and developing interventions that delay or prevent the development of both primary and secondary OA and other musculoskeletal pathologies. The overall objectives of this proposal are to: 1) quantify the relationship between walking mechanics after ACL surgery and early signs of patellofemoral OA; and 2) determine the effects of post-operative neuromuscular training on walking mechanics after ACL surgery. The central hypotheses are that: 1) walking mechanics will correlate to early patellofemoral OA; and 2) walking mechanics will improve after neuromuscular training. Aim 1 will quantify the relationship between walking gait mechanics and patellofemoral (trochlear) cartilage T2 relaxation times (indicative of joint degeneration) 6 months after ACL surgery. Aim 2 will determine the effect of a specialized postoperative neuromuscular training program on the walking mechanics of athletes after ACL surgery. Walking analyses will be conducted 6 months after surgery for Aim 1 and before and after neuromuscular training as well as 1 and 2 years after surgery for Aim 2. Data will be analyzed for both aims using a validated musculoskeletal modeling approach to provide muscle and joint contact forces in addition to joint angles and moments. Quantitative magnetic resonance imaging data will also be collected 6 months after surgery for aim 1, and T2 relaxation times will be used to quantify cartilage health. The results of this project will advance rehabilitation science and clinical practice by critically evaluating the development of knee OA and rehabilitation strategies targeting a known risk factor for OA development. Findings will help improve musculoskeletal health, function, and quality of life. This proposal will also provide the applicant the foundation to conduct high quality longitudinal interventional and observational studies in rehabilitation, write compelling and impactful proposals, take research to its ultimate conclusion, publish in peer-reviewed journals, and prepare for a career as an independent clinician-scientist.