New potential to restore neuromuscular and joint function after ACL injury

该项目的目的是确定是否新的桥梁加强前交叉韧带 与标准治疗相比，BEAR手术可恢复生物力学膝关节功能 前交叉韧带重建（ACLR），改善ACL损伤后的患者结局。 BEAR手术与ACLR不同，因为它使用支架来促进受损ACL的愈合 而ACLR需要切除整个韧带，这会切断然后切除神经结构 在本机ACL中。BEAR的临床研究表明， 熊，但不是ACLR后，即使在2年。BEAR患者还报告了上级运动相关质量， 早在康复期。我们假设，这些差异是由于保存的神经 活动和神经肌肉反馈。因此，我们的总体假设是，熊 保留了膝关节周围的神经肌肉激活模式，从而促进正常的跳跃着陆 与ACLR相比，关节活动度和相应的患者报告结局。涉及三个目标： 1)使用我们新的机器学习方法将神经肌肉活动模式分类为 ACLR、BEAR或健康对照受试者（对照）; 2）比较膝关节的胫股位置 当单腿跳着陆时，ACLR、BEAR和地面接触处的控制之间的关系;以及3）检查 功能测量与KOOS运动相关患者报告结局之间的相关性。 在罗得岛医院（BEAR-MOON）入组的26例受试者参加了一项母公司随机临床试验 将在2年随访访视时入组拟定研究。年龄和性别匹配的对照组 也将从社区中招募。所有39名受试者将进行单腿跳跃距离活动， 记录表面肌电图以评估神经肌肉功能（目的1）， 将进行影像学检查，以评价精确的胫股运动（目标2）。之间的关系 将使用回归分析测试患者报告和生物力学结局指标（目标3）。如果 所提出的研究假设得到支持，结果将表明，神经生理 BEAR恢复的机制与ACLR有根本的不同，它们具有 对患者运动相关生活质量的显著影响目前未通过传统ACL损伤解决 治疗。

The project objective is to determine whether the novel bridge-enhanced anterior cruciate ligament restoration (BEAR) procedure restores biomechanical knee function compared to the standard of care anterior cruciate ligament reconstruction (ACLR), leading to improved patient outcomes after ACL injury. The BEAR procedure differs from ACLR as it uses a scaffold to promote healing of the injured ACL whereas ACLR requires removal of the entire ligament, which severs and then removes neural structures within the native ACL. Clinical studies of BEAR have shown that muscle strength is restored following BEAR but not after ACLR, even at 2 years. BEAR patients also reported superior sports-related quality of life earlier in their recovery. We postulate that these differences are due to the preservation of neural activity and neuromuscular feedback with BEAR. Therefore, our overarching hypothesis is that BEAR preserves the neuromuscular activation patterns about the knee that, in turn, promote normal hop landing joint motion and corresponding patient-reported outcomes compared to ACLR. Three aims are addressed: 1) to use our novel machine learning approach to classify neuromuscular activity patterns as belonging to ACLR, BEAR or healthy control subjects (Controls); 2) to compare the tibiofemoral positions of the knee between ACLR, BEAR, and Controls at ground contact when landing from a 1-leg hop; and 3) to examine the correlation between functional measures and KOOS sports-related patient-reported reported outcomes. Twenty-six subjects enrolled in a parent randomized clinical trial at Rhode Island Hospital (BEAR-MOON) will be enrolled in the proposed study at their 2-year follow-up visit. An age- and sex-matched control group will also be recruited from the community. All 39 subjects will perform a 1-leg hop-for-distance activity while surface electromyography is recorded to assess neuromuscular function (Aim 1), and biplane videoradiography will be performed to evaluate precise tibiofemoral motion (Aim 2). Relationships between patient-reported and biomechanical outcome measures will be tested using regression analyses (Aim 3). If the hypotheses of the proposed study are supported, the results will demonstrate that neurophysiological mechanisms underlying BEAR recovery are fundamentally different from ACLR and that they have a significant impact on patient sports-related quality of life not currently addressed by conventional ACL injury treatments.