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.

项目摘要/摘要 在美国，每年有超过四分之一的人每年撕裂其前交叉韧带（ACL），并且 随后，大多数经过手术重建（ACLR）。尽管进行了广泛的康复，但 ACLR后，与不对称的膝关节力学一起持续行走。即使在ACL重建后几年 他们回到体育活动后很久，个人以微妙的步态不对称行走 个体可以检测到或感知的。这些小的不对称，但是，直接贡献 发育早期发作，创伤后膝关节骨关节炎。 骨关节炎在ACL损伤后5 - 15年发展，并对个人产生毁灭性的影响。早期的 骨关节炎与运动和休闲参与，疼痛和自我降低直接相关 报告的生活质量。随着ACL破裂和重建的峰值年龄为16岁，女孩和17岁 在男孩中，大多数人都可以在成年后发展膝盖骨关节炎。目标的目标 奖学金是应用运动学习原理，以直接针对不对称的膝关节力学 ACLR之后的个体。使用拆分的皮带短期改变步行力学的潜力（一条皮带下方 每只脚以不同的速度移动）跑步机已在神经系统中得到证明 人群。该奖学金将使用脱离皮带的跑步机改编范式来了解个人如何 ACL重建后适应膝关节力学。此外，这项工作将评估 通过量化膝关节动力学的变化和 运动学。具体而言，该提案将确定ACLR之后的个人可以适应的程度（AIM 1）与未受伤 个人。这项工作将为ACLR之后的个人的运动学习提供宝贵的见解， 纠正有害的步行力学所必需的。该奖学金申请人的长期目标是 开发了有针对性的干预措施，以优化攻击并最终降低创伤后膝盖的速度 ACLR后骨关节炎。拟议工作的发现将有助于设计康复干预措施 术后早期的ACL康复。这项研究有可能提高术后身体 治疗干预措施并影响早发膝关节骨关节炎的发展，有可能改善 ACLR之后的活动水平和生活质量。此外，该提案将促进申请人的占主导地位 培训，为作为独立临床科学家的职业奠定了基础。