Can we modify gait asymmetry after ACL reconstruction?

ACL 重建后我们可以改变步态不对称吗？

• 批准号: 10313330
• 负责人: Elanna Arhos
• 金额: $ 4.6万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-28 至 2023-06-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10313330
• 关键词: 16 year old; 17 year old; Address; Affect; Age; Amputation; Anterior Cruciate Ligament; Biomechanics; Biometry; Characteristics; Clinical; Data; Degenerative polyarthritis; Delaware; Development; Early Intervention; Environment; Extensor; Feedback; Fellowship; Foundations; Gait; Goals; Impairment; Individual; Injury; Intervention; Kinetics; Knee; Knee Osteoarthritis; Knee joint; Knowledge; Learning; Limb structure; Link; Literature; Mechanics; Mentorship; Movement; Neuraxis; Neurologic; Neuronal Plasticity; Operative Surgical Procedures; Orthopedics; Outcome; Pain; Patient Self-Report; Pattern; Phase; Physical therapy; Population; Postdoctoral Fellow; Postoperative Period; Property; Publishing; Quality of life; Recovery; Rehabilitation therapy; Research; Scientist; Speed; Sports; Stroke; Therapeutic Intervention; Training; Universities; Walking; Work; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; boys; career; design; early onset; effective intervention; evidence base; foot; girls; improved; improved outcome; insight; joint injury; kinematics; knee mechanics; knee replacement arthroplasty; learning strategy; motor control; motor learning; neuromuscular; neuromuscular system; neuroregulation; novel; pre-doctoral; premature; reconstruction; return to sport; risk minimization; skills; somatosensory; spatiotemporal; tendon graft; theories; therapy design; therapy development; treadmill; treadmill training; young adult

PROJECT SUMMARY/ABSTRACT More than a quarter of a million people in the US tear their anterior cruciate ligaments (ACL) each year, and most subsequently undergo surgical reconstruction (ACLR). Despite extensive rehabilitation, individuals persistently walk with asymmetrical knee joint mechanics after ACLR. Even years after ACL reconstruction, long after they have returned to sporting activities, individuals walk with subtle gait asymmetries that are not clinically detectable or perceived by the individual. These small asymmetries, nevertheless, directly contribute to the development of early-onset, post-traumatic knee joint osteoarthritis. Post-traumatic knee joint osteoarthritis develops 5-15 years after ACL injury and carries devastating implications for the individual. Early osteoarthritis is directly associated with decreased sports and recreational participation, pain, and lower self- reported quality of life. As the peak age of ACL rupture and reconstruction is 16 years old in girls and 17 years old in boys, most are on track to develop knee osteoarthritis in young adulthood. The objectives of this fellowship are to apply principles of motor learning to directly target the asymmetric knee joint mechanics in individuals after ACLR. The potential to change walking mechanics short-term using a split-belt (one belt under each foot moving at different speeds) treadmill has been demonstrated in neurologic and uninjured populations. This fellowship will use a split-belt treadmill adaptation paradigm to understand how individuals after ACL reconstruction adapt knee joint mechanics. Further, this work will assess the carry-over of a bout of split-belt treadmill training on over-ground walking symmetry by quantifying changes in knee joint kinetics and kinematics. Specifically, the proposal will determine the extent to which individuals after ACLR can adapt (Aim 1) retain (Aim 2), and overground transfer (Aim 3) improved knee joint mechanics compared to uninjured individuals. This work will provide valuable insight into motor learning in individuals after ACLR, which is necessary to correct detrimental walking mechanics. The long-term goal of this fellowship applicant is to develop targeted interventions to optimize gait and ultimately reduce the rate of posttraumatic knee osteoarthritis after ACLR. Findings from the proposed work will aid in the design of rehabilitation interventions for early post-operative ACL rehabilitation. This research has potential to advance post-operative physical therapy interventions and affect the development of early-onset knee osteoarthritis, potentially improving activity levels and quality of life after ACLR. Further, this proposal will facilitate the applicant’s predoctoral training, laying the foundation for a career as an independent clinician-scientist.

项目概要/摘要 在美国，每年有超过 25 万人的前十字韧带 (ACL) 撕裂，并且 尽管进行了广泛的康复治疗，但大多数人随后接受了手术重建（ACLR）。 即使在 ACL 重建后数年，仍能以不对称的膝关节力学状态行走。 在他们恢复体育活动很久之后，人们走路时会出现微妙的步态不对称，这是不对称的。 然而，这些微小的不对称性在临床上可被个体察觉或感知。 导致早发性、创伤后膝关节骨关节炎的发展。 骨关节炎在 ACL 损伤后 5-15 年内发生，对个人造成毁灭性影响。 骨关节炎与运动和娱乐参与减少、疼痛和自我意识降低直接相关。 据报道，ACL 断裂和重建的高峰年龄是女孩 16 岁和 17 岁。 在男孩中，大多数人在成年后都会患上膝骨关节炎。 奖学金将应用运动学习原理直接针对不对称膝关节力学 ACLR 后的个体使用分体带（下一根带）短期改变步行力学的潜力。 每只脚以不同的速度移动）跑步机已在神经系统和未受伤的情况下得到证实 该奖学金将使用分体带跑步机适应范式来了解个体如何适应。 ACL 重建后适应膝关节力学此外，这项工作将评估一轮的遗留情况。 通过量化膝关节动力学的变化，对地上步行对称性进行分带式跑步机训练 具体来说，该提案将确定 ACLR 后个体可以适应的程度（目标） 1) 与未受伤者相比，保留（目标 2）和地上转移（目标 3）改善膝关节力学 这项工作将为 ACLR 之后的个人运动学习提供有价值的见解。 纠正不适的步行力学所必需的 该奖学金申请人的长期目标是 制定有针对性的干预措施以优化步态并最终降低膝盖创伤后的发生率 ACLR 后骨关节炎的研究结果将有助于康复干预措施的设计。 这项研究有可能促进术后身体康复。 治疗干预并影响早发性膝骨关节炎的发展，可能会改善 此外，该提案还将促进申请人的博士前学习。 培训，为独立临床医生科学家的职业生涯奠定基础。