Can Neuromuscular Training Alter Movement Patterns?

描述（由申请人提供）：前交叉韧带（ACL）损伤是常见的，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改善前交叉韧带重建后的预后，并减少发生膝关节OA的高危人群的适应不良。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。手术前后将使用运动分析和x线摄影进行评估，体内运动学、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，非铜伤患者将：1)表现出动态稳定性患者的运动和肌肉放电模式特征，2)这些变化将在重建后持续存在，3)训练引起的运动和肌肉放电模式的变化将导致重建后更好的功能结果。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，如果术前扰动训练既能改善患者的预后，又能减少前交叉韧带重建手术后的适应不良，那么这些发现可能适用于范围广泛的膝关节损伤患者。

DESCRIPTION (provided by applicant): 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 improve outcome and reduce maladaptations after ACL reconstruction 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, non-copers will: 1) demonstrate movement and muscle firing patterns that are characteristic of those with dynamic stability, 2) these changes will persist after reconstruction and 3) training induced changes in movement and muscle firing patterns will result in better functional outcomes after reconstruction. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACL's each year and undergo reconstructive surgery. More importantly, if pre-operative perturbation training can facilitate both improved patient outcomes and a reduction in maladaptions following reconstructive ACL surgery, these findings may have applications for individuals with an extensive range of knee injuries.