Prognostic Study of the Risk Factors for Contralateral ACL Injury

项目摘要 前十字韧带(ACL)的损伤使人非常虚弱；每年有超过12万人受到影响 美国的个人和全球的140万人。据估计，这些人中有三分之一将 对侧膝关节或前交叉韧带移植物随后遭受相同类型的损伤。不仅这些伤痕 导致运动和活动损失的时间，立即去标签，通常需要手术，他们是 与膝关节创伤后骨关节炎(PTOA)相关，无论治疗类型是什么 被选中了。相比之下，由于发病较早，前交叉韧带损伤和随之而来的PTOA后遗症使人虚弱 到特发性骨关节炎(OA)，造成了相当大的治疗问题，因为大多数这些伤害 发生在15至25岁的活跃的年轻人中，他们对关节的要求很高， 因此需要更早和更频繁的手术和康复。 在之前的资助期间，我们确定了第一次前交叉韧带撕裂的风险因素(请参阅进展 报告以获取详细信息)。该研究中受伤运动员的一部分在手术、康复 并重返运动领域两年，18%的人对侧前交叉韧带完全崩溃 (CACL)，10.9%发生移植物损伤(总再损伤率28.9%)。而不是治疗这种创伤和 随后通过手术途径进行PTOA的负担，这些方法只取得了轻微的成功， 积极主动的方法是识别出前交叉韧带损伤和发生损伤的风险增加的个体 旨在降低这一风险的预防计划。此应用程序中的研究重点是建立一个 完全了解CACL损伤的危险因素。这是理解以下内容的关键一步 为什么会发生这些损伤，制定考虑先前前交叉韧带损伤的预防策略，以及 用于识别那些遭受反复前交叉韧带损伤风险最大的人，以便将他们作为目标 伤害预防干预措施。 这项调查的目标将是确定与以下各项有关的全面风险因素 在从第一次前交叉韧带损伤中恢复并重返运动/活动后，遭受CACL。这将是 通过执行以下具体目标来实现： 1.前瞻性地识别和招募首次遭受前交叉韧带损伤的高中和大学运动员。 2.在发生CACL损伤时，测量一套全面的潜在危险因素 运动员在接受治疗和康复后重返运动/活动的情况。这将包括解剖、力量和 对侧小腿的神经肌肉测量，以及临床、人口统计学和环境因素。 3.跟踪研究对象一段时间，以确定随后对CACL的非接触性损伤。 4.确定与CACL损伤风险相关的风险因素组合 雄性和雌性。

Project Summary Injuries to the anterior cruciate ligament (ACL) are highly debilitating; each year they affect more than 120,000 individuals in the United States and 1.4 million worldwide. It is estimated that one-third of these individuals will suffer subsequent truama of the same kind to the contralateral knee or ACL graft. Not only do these injuries result in time lost from sport and activity, are immediatley disabeling, and typically require surgery, they are associated with post traumatic osteoarthritis (PTOA) of the knee regardless of the type of treatment that is chosen. ACL injury and the subsequent sequela of PTOA is debilitating due to its earlier onset in comparison to idiopathic osteoarthritis (OA), creating a considerable therapeutic concern as a majority of these injuries occur in active young individuals between 15 and 25 years of age that place high demand on their joints and consequently require earlier and more frequent surgery and rehabilitation. During the prior funding interval, we determined the risk factors for a first time ACL tear (please see Progress Report for details). A subset of the injured athletes from that study were followed after surgery, rehabilitation and return to sport for 2 years, and 18% went on to suffer a complete disruption of their contralateral ACL (CACL), and 10.9% suffered a graft injury (total re-injury rate of 28.9%). Rather than treat this trauma and the subsequent burden of PTOA though surgical approaches, which are only marginally successful, a more proactive approach is to identify individuals at increased risk of suffering ACL injury and develop injury prevention programs to mitigate that risk. The investigation in this application is focused on establishing a complete understanding of the risk factors for a CACL injury. This is an essential next step for understanding why these injuries occur, the development of prevention strategies that take prior ACL injury into account, and for identifying those that are at the greatest risk of suffering repeated ACL trauma so they can be targeted for injury prevention interventions. The goal of this investigation will be to determine the comprehensive set of risk factors associated with suffering a CACL following recovery form a first time ACL injury and return to sport/activity. This will be accomplished by executing the following Specific Aims: 1. To prospectively identify and recruit high school and college athletes who suffer a first-time ACL injury. 2. To measure a comprehensive set of potential risk factors for subsequent CACL injury at the time of the athlete's return to sport/activity following treatment and rehabilitation. These will include anatomic, strength and neuromuscular measurements on the contralateral leg, and clinical, demographic, and environmental factors. 3. To follow study subjects over time to identify subsequent non-contact injury to the CACL. 4. To determine combinations of risk factors that are associated with the risk of suffering a CACL injury in males and females.