Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes

针对女运动员 ACL 负荷机制的神经肌肉干预

• 批准号: 8123294
• 负责人: Timothy E Hewett
• 金额: --
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8123294
• 关键词: Address; Anterior Cruciate Ligament; Biomechanics; Body Weight; Data; Degenerative polyarthritis; Double-Blind Method; Drops; Educational Intervention; Evidence based intervention; Exercise; Female; Goals; Health; Hip region structure; Injury; Intervention; Knee; Lateral; Leg; Limb structure; Link; Manufactured basketball; Medial; Motion; Positioning Attribute; Randomized Controlled Trials; Reaction; Relative (related person); Risk; Sensitivity and Specificity; Soccer; Specificity; Sports; Testing; Torque; Training; Training Programs; Validation; Women' s Group; Work; combinatorial; design; evidence base; foot; high risk; injured; ligament injury; male; neuromuscular; therapy design; vector; Address; Anterior Cruciate Ligament; Biomechanics; Body Weight; Data; Degenerative polyarthritis; Double-Blind Method; Drops; Educational Intervention; Evidence based intervention; Exercise; Female; Goals; Health; Hip region structure; Injury; Intervention; Knee; Lateral; Leg; Limb structure; Link; Manufactured basketball; Medial; Motion; Positioning Attribute; Randomized Controlled Trials; Reaction; Relative (related person); Risk; Sensitivity and Specificity; Soccer; Specificity; Sports; Testing; Torque; Training; Training Programs; Validation; Women' s Group; Work; combinatorial; design; evidence base; foot; high risk; injured; ligament injury; male; neuromuscular; therapy design; vector

DESCRIPTION (provided by applicant): Females who participate in cutting and landing sports suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Fifty to 100 percent of ACL injured females will suffer osteoarthritis of the injured knee within one to two decades of the injury. External knee abduction moment (LOAD) predicts ACL injury with high sensitivity and specificity in female athletes. Control of lateral trunk motion (LTM) also predicts ACL injury with similar levels of sensitivity and specificity in female athletes. These predictors may be linked, as lateral positioning of the trunk can induce knee abduction load via both biomechanical and neuromuscular mechanisms. The mechanism of ACL injury in females most often includes high knee LOAD and high LTM, with the majority of body weight shifted over the injured limb and the foot positioned lateral to the body's center of mass. An unanticipated perturbation is also often a contributor to the injury mechanism. LTM may result in increased knee LOAD via lateral positioning and increased magnitude of the GRF vector ( GRFv) or by altered reactive hip adductor torque (HAdT). Our long-term objectives are to determine the mechanisms that increase ACL injury risk in female athletes and to develop neuromuscular training (NMT) interventions that specifically target these mechanisms. If the objectives of this proposal are achieved, an evidence-based NMT intervention will be developed and made available nationally that will effectively and efficiently reduce ACL injury risk in high-risk female athletes. The major goal of this proposal is to determine if increased LTM alters LOAD in female athletes. This application will test the central hypotheses that LTM increases knee LOAD and that NMT that is targeted toward increasing coronal plane control of trunk motion will decrease LOAD in females. Aim 1 is designed to determine the mechanisms by which trunk motion may increase knee LOAD in female athletes. Coronal plane control of the trunk (LTM) will be examined relative to GRFv, HAdT and knee LOAD. We will determine if increased LTM increases knee LOAD via biomechanical (increased GRFv) and/or neuromuscular (increased relative HAdT) mechanisms. The central hypothesis of Aim 1 is that increased LTM will increase knee LOAD in female athletes by increasing GRFv, by increasing HAdT or via a combination of these mechanisms during cutting and landing. We hypothesize that females with neither mechanism will have low knee LOAD, those with increased GRFv or HAdT will have moderate LOAD and those with increased GRFv and HAdT will have high knee LOAD. Aim 2 is designed to determine if NMT targeted to decreases coronal plane trunk motion (TNMT) will decrease both LTM and knee LOAD to a greater extent than sham/control training in a randomized controlled trial (RCT). The primary hypothesis of Aim 2 is that TNMT will decrease LTM and knee LOAD. Secondary hypotheses will test relationships between changes in LTM, GRFv, HAdT and LOAD with TNMT using Post-Hoc analysis. Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes. PUBLIC HEALTH RELEVANCE. Females who participate in cutting and landing sports like soccer and basketball suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Our previous work shows that lateral knee load and trunk motion can each independently increase ACL injury risk in female athletes. The major objectives of this proposal are to determine how lateral trunk motion increases knee load in female athletes who are at greater risk ACL injury and to develop exercise training programs that decrease trunk motion, knee load and ACL injury risk in these high-risk athletes.

描述（由申请人提供）：参加切割和着陆运动的女性遭受前交叉韧带（ACL）受伤，比参加相同高风险运动的男性高2至10倍。 ACL受伤的女性中有50％至100％会在受伤的一到二十年内遭受受伤的膝盖骨关节炎。外部膝盖绑架力矩（负载）可预测女运动员的高灵敏度和特异性的ACL损伤。对侧躯干运动（LTM）的控制还可以预测女运动员的敏感性和特异性水平相似的ACL损伤。这些预测因子可以连接，因为躯干的横向定位可以通过生物力学和神经肌肉机制诱导膝盖外展负荷。女性中ACL损伤的机制通常包括高膝盖和高LTM，大部分体重在受伤的肢体上移动，脚侧向侧面放在身体的质量中心。意外的扰动通常也是造成伤害机制的原因。 LTM可能通过横向定位和GRF载体（GRFV）的幅度增加或通过改变反应性髋关节内收扭矩（HADT）而导致膝关节负荷增加。我们的长期目标是确定增加女运动员中ACL损伤风险的机制，并开发专门针对这些机制的神经肌肉训练（NMT）干预措施。如果实现了该提案的目标，将制定基于证据的NMT干预措施并在全国范围内提供，从而有效，有效地降低高危女运动员的ACL伤害风险。该提案的主要目标是确定LTM增加是否改变了女运动员的负载。该应用将测试中心假设，即LTM增加了膝关节负荷，并且针对增加躯干运动的冠状平面控制的NMT将减少女性的负载。 AIM 1旨在确定躯干运动可以增加女运动员膝盖负荷的机制。将检查躯干（LTM）的冠状平面控制，相对于GRFV，HADT和膝盖负荷。我们将通过生物力学（增加的GRFV）和/或神经肌肉（相对HADT）机制来确定LTM增加是否会增加膝关节负荷。 AIM 1的中心假设是，增加的LTM将通过增加HADT或通过在切割和着陆期间增加这些机制的组合来增加女运动员的膝盖负荷。我们假设具有机制的女性膝盖负荷较低，GRFV或HADT增加的女性将具有适度的载荷，而GRFV和HADT增加的女性将具有较高的膝关节负荷。 AIM 2旨在确定针对降低冠状平面躯干运动（TNMT）的NMT是否将在随机对照试验（RCT）中更大程度地降低LTM和膝盖载荷。 AIM 2的主要假设是TNMT将减少LTM和膝盖载荷。次要假设将使用事后分析测试LTM，GRFV，HADT和LOAD和TNMT的变化之间的关系。神经肌肉干预针对女运动员的ACL负载机制。 公共卫生相关性。 参加切割和着陆运动的女性，例如足球和篮球，遭受前交叉韧带（ACL）受伤，比参加同样的高风险运动的男性高2至10倍。我们以前的工作表明，侧膝盖负荷和躯干运动可以独立增加女运动员的ACL损伤风险。该提案的主要目标是确定横向躯干运动如何增加患ACL损伤风险更大的女运动员的膝盖负荷，并开发锻炼训练计划，以减少这些高危运动员的躯干运动，膝盖负荷和ACL损伤风险。