The Effects of Vibration on Quadriceps Function and Landing Biomechanics in Individuals with Anterior Cruciate Ligament Reconstruction

振动对前十字韧带重建个体股四头肌功能和着陆生物力学的影响

• 批准号: 10536986
• 负责人: Thomas B Birchmeier
• 金额: $ 7.07万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536986
• 关键词: Acute; Biomechanics; Clinical; Clinical Trials; Degenerative polyarthritis; Development; Failure; Fostering; Functional disorder; Gait; Health; Individual; Injury; Intervention; Joints; Knee; Knee Injuries; Knee joint; Leg; Limb structure; Lower Extremity; Mechanics; Modality; Muscle; Operative Surgical Procedures; Outcome; Outcome Study; Patients; Phase; Physical activity; Probability; Production; Protocols documentation; Randomized Controlled Trials; Reaction; Reconstructive Surgical Procedures; Recording of previous events; Reflex action; Rehabilitation therapy; Research Personnel; Risk; Single-Blind Study; Statistical Data Interpretation; Time; Torque; Training; absorption; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; base; biomechanical test; early onset; evidence base; experience; high risk; improved; indexing; joint loading; meetings; neuromuscular function; quadriceps muscle; rehabilitation strategy; rehabilitative care; response; skills; somatosensory; vibration

PROJECT SUMMARY The risk of sustaining a second anterior cruciate ligament (ACL) injury is 6 times greater following ACL reconstruction surgery (ACLR) compared to those without a history of ACL injury and poses significant risk to long term knee joint health (i.e., early onset osteoarthritis and poor quadriceps function). Mechanical knee stability is restored after ACLR; however, functional deficits such as quadriceps dysfunction often persist and result in high-risk lower extremity biomechanics and abnormal joint loading that increase the risk of a second ACL injury. Evidence-based return to physical activity (RTPA) criteria have been developed to identify at risk individuals after ACLR based on between limb symmetry (limb symmetry index, LSI) on single leg tasks (i.e. hopping and landing) and quadriceps strength. Meeting RTPA criteria (>90% LSI) can reduce the secondary injury rate by 84%; however few individuals (11-57%) with ACLR treated with standard rehabilitation meet RTPA criteria before reengaging in unrestricted physical activity. As the primary contributor to poor landing biomechanics, failure to meet RTPA criteria, and ultimately secondary ACL injury, there is a need to develop interventions to alleviate persistent quadriceps dysfunction post-ACLR. Whole body vibration (WBV) and local muscle vibration (LMV) excite the quadriceps and increase force production that potentially improves knee stability during landing, hence mitigating risk of second ACL injury. Vibration also acutely improves voluntary quadriceps function (i.e., peak torque, and EMG amplitude) and mitigates aberrant gait biomechanics in individuals with ACLR. To that end, previous clinical trials indicate that vibration (WBV and LMV) embedded in ACLR rehabilitation improves quadriceps function and somatosensory function to a greater extent than rehabilitation alone. However, the longitudinal effects of vibration rehabilitation on quadriceps dysfunction and subsequent reduction in high-risk biomechanics associated with second ACL injury and objective RTPA criteria have not been evaluated. Therefore, the objective of this proposal is to assess the effects of vibration rehabilitation (WBV and LMV) on quadriceps function, landing biomechanics, and the likelihood of meeting RTPA criteria at 6 and 12 months post-ACLR. The central hypothesis is that 1) Vibration rehabilitation will enhance quadriceps function during landing, 2) Vibration rehabilitation will enhance lower extremity biomechanics during lading (i.e. peak sagittal and frontal plane angles and moments and vertical ground reaction force), and 3) the Vibration rehabilitation groups will have greater odds of meeting RTPA criteria than the Standard Rehabilitation group at 6 and 12 months post-ACLR. Completion of this project and the training plan detailed in this application in conjunction with direct interaction with my sponsor and collaborators enable me to develop new skills in clinical trial management, neuromuscular function assessment, and advanced statistical analysis and foster my development as a successful independent clinical researcher.

项目概要 ACL 术后第二次前十字韧带 (ACL) 损伤的风险增加 6 倍 与没有 ACL 损伤史的患者相比，重建手术 (ACLR) 的风险更大 长期膝关节健康（即早发性骨关节炎和股四头肌功能不佳）。机械膝关节 ACLR后恢复稳定；然而，股四头肌功能障碍等功能缺陷经常持续存在， 导致高风险的下肢生物力学和异常的关节负荷，增加第二次发生的风险 前交叉韧带损伤。制定了基于证据的体力活动恢复 (RTPA) 标准来识别风险 ACLR 后的个体基于单腿任务（即肢体对称指数，LSI）之间的肢体对称性（即 LSI） 跳跃和着陆）和股四头肌力量。满足 RTPA 标准（>90% LSI）可以减少次级 伤害率降低84%；然而，接受标准康复治疗的 ACLR 患者很少（11-57%）符合 重新进行不受限制的体力活动之前的 RTPA 标准。作为着陆不良的主要原因 生物力学，未能满足 RTPA 标准，最终导致继发性 ACL 损伤，因此需要开发 缓解 ACLR 后持续性股四头肌功能障碍的干预措施。全身振动（WBV）和局部振动 肌肉振动 (LMV) 激发股四头肌并增加力量产生，从而可能改善膝盖 着陆时的稳定性，从而降低第二次 ACL 损伤的风险。振动还可以显着提高自主性 股四头肌功能（即峰值扭矩和肌电图振幅）并减轻异常步态生物力学 患有 ACLR 的个体。为此，之前的临床试验表明振动（WBV 和 LMV）嵌入 ACLR康复训练对股四头肌功能和体感功能的改善程度比 单独康复。然而，振动康复对股四头肌功能障碍的纵向影响和 随后减少与第二次 ACL 损伤相关的高风险生物力学和客观 RTPA 标准 尚未评估。因此，该提案的目的是评估振动的影响 对股四头肌功能、着陆生物力学以及满足的可能性进行康复（WBV 和 LMV） ACLR 后 6 个月和 12 个月的 RTPA 标准。中心假设是 1) 振动康复将 增强着陆时股四头肌功能，2）振动康复将增强下肢功能 装载过程中的生物力学（即峰值矢状面和额面角度和力矩以及垂直地面 反作用力），3）振动康复组比 RTPA 标准更有可能达到 ACLR 后 6 个月和 12 个月的标准康复组。完成本项目及培训 本申请中详细的计划以及与我的赞助商和合作者的直接互动使得 我培养临床试验管理、神经肌肉功能评估和先进的新技能 统计分析并促进我作为一名成功的独立临床研究员的发展。