The Effects of Vibration on Quadriceps Function and Landing Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction

项目总结 第二次前交叉韧带(ACL)损伤的风险是前十字韧带(ACL)损伤的6倍 重建手术(ACLR)与那些没有前交叉韧带损伤病史的患者相比，具有显著的风险 长期的膝关节健康(即早发性骨关节炎和股四头肌功能不良)。机械式膝盖 稳定性在ACLR后恢复；然而，功能缺陷，如股四头肌功能障碍，往往持续和 导致高风险的下肢生物力学和异常的关节负荷，增加了第二次骨折的风险 前交叉韧带损伤。基于证据的恢复体力活动(RTPA)标准已经被开发来识别风险 ACLR后的个体基于单腿任务(即， 跳跃和落地)和股四头肌力量。满足RTPA标准(&gt；90%LSI)可以减少二次 伤害率降低84%；然而，接受标准康复治疗的ACLR患者寥寥无几(11-57%) 在重新从事不受限制的体力活动之前，应符合RTPA标准。作为糟糕着陆的主要贡献者 生物力学，未能达到RTPA标准，最终导致继发性前交叉韧带损伤，有必要制定 缓解ACLR术后持续性股四头肌功能障碍的干预措施。全身振动(WBV)和局部振动 肌肉振动(LMV)刺激股四头肌，增加力量产生，从而潜在地改善膝盖 着陆时的稳定性，因此降低了二次前交叉韧带损伤的风险。振动也大大提高了自愿性。 股四头肌功能(即峰值扭矩和肌电幅度)和减轻异常步态的生物力学 患有ACLR的个体。为此，先前的临床试验表明，嵌入在体内的振动(WBV和LMV) ACLR康复在更大程度上改善股四头肌功能和躯体感觉功能 光是康复就可以了。然而，振动康复对股四头肌功能障碍和 与第二前交叉韧带损伤相关的高危生物力学的后续减少和客观的RTPA标准 还没有经过评估。因此，这项建议的目的是评估振动的影响 康复(WBV和LMV)对股四头肌功能、着陆生物力学和相遇可能性的影响 术后6个月和12个月的RTPA标准。中心假设是1)振动康复将 增强着陆过程中股四头肌功能，2)振动康复可增强腿部功能 装货过程中的生物力学(即峰值、矢状面、前平面角和力矩以及垂直地面 反作用力)，以及3)振动康复组达到RTPA标准的几率比 标准康复组在ACLR术后6个月和12个月。完成本项目和培训 此应用程序中详细的计划与我的赞助商和协作者的直接交互一起启用 我将在临床试验管理、神经肌肉功能评估和高级 统计分析和培养我作为一名成功的独立临床研究人员的发展。

PROJECT SUMMARY The risk of sustaining a second anterior cruciate ligament (ACL) injury is 6 times greater following ACL reconstruction surgery (ACLR) compared to those without a history of ACL injury and poses significant risk to long term knee joint health (i.e., early onset osteoarthritis and poor quadriceps function). Mechanical knee stability is restored after ACLR; however, functional deficits such as quadriceps dysfunction often persist and result in high-risk lower extremity biomechanics and abnormal joint loading that increase the risk of a second ACL injury. Evidence-based return to physical activity (RTPA) criteria have been developed to identify at risk individuals after ACLR based on between limb symmetry (limb symmetry index, LSI) on single leg tasks (i.e. hopping and landing) and quadriceps strength. Meeting RTPA criteria (>90% LSI) can reduce the secondary injury rate by 84%; however few individuals (11-57%) with ACLR treated with standard rehabilitation meet RTPA criteria before reengaging in unrestricted physical activity. As the primary contributor to poor landing biomechanics, failure to meet RTPA criteria, and ultimately secondary ACL injury, there is a need to develop interventions to alleviate persistent quadriceps dysfunction post-ACLR. Whole body vibration (WBV) and local muscle vibration (LMV) excite the quadriceps and increase force production that potentially improves knee stability during landing, hence mitigating risk of second ACL injury. Vibration also acutely improves voluntary quadriceps function (i.e., peak torque, and EMG amplitude) and mitigates aberrant gait biomechanics in individuals with ACLR. To that end, previous clinical trials indicate that vibration (WBV and LMV) embedded in ACLR rehabilitation improves quadriceps function and somatosensory function to a greater extent than rehabilitation alone. However, the longitudinal effects of vibration rehabilitation on quadriceps dysfunction and subsequent reduction in high-risk biomechanics associated with second ACL injury and objective RTPA criteria have not been evaluated. Therefore, the objective of this proposal is to assess the effects of vibration rehabilitation (WBV and LMV) on quadriceps function, landing biomechanics, and the likelihood of meeting RTPA criteria at 6 and 12 months post-ACLR. The central hypothesis is that 1) Vibration rehabilitation will enhance quadriceps function during landing, 2) Vibration rehabilitation will enhance lower extremity biomechanics during lading (i.e. peak sagittal and frontal plane angles and moments and vertical ground reaction force), and 3) the Vibration rehabilitation groups will have greater odds of meeting RTPA criteria than the Standard Rehabilitation group at 6 and 12 months post-ACLR. Completion of this project and the training plan detailed in this application in conjunction with direct interaction with my sponsor and collaborators enable me to develop new skills in clinical trial management, neuromuscular function assessment, and advanced statistical analysis and foster my development as a successful independent clinical researcher.