Precision rehabilitation to restore plantar flexor function following Achilles tendon rupture repair

跟腱断裂修复后精准康复恢复跖屈肌功能

• 批准号: 10676891
• 负责人: Josh Baxter
• 金额: $ 17.88万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676891
• 关键词: Animal Model; Animals; Ankle; Biofeedback; Biological; Biomechanics; Caring; Clinic; Clinical; Clinical Management; Consensus; Data; Electrodes; Environment; Feedback; Female; Flexor; Frequencies; Future; Guidelines; Immobilization; Implant; Injury; Insurance; Laboratories; Length; Mechanics; Mediating; Medicine; Modeling; Monitor; Motion; Muscle; Muscle Contraction; Muscle Fibers; Nerve; Operative Surgical Procedures; Outcome; Outcome Study; Patients; Physical Rehabilitation; Physical therapy; Pre-Clinical Model; Protocols documentation; Publishing; Rattus; Recovery; Rehabilitation therapy; Rupture; Sarcomeres; Structure; Structure of tibial nerve; Tendon Injuries; Tendon structure; Testing; Therapeutic; Torque; Translating; Translations; Woman; Work; achilles tendon; clinical care; clinically relevant; evidence base; experimental group; experimental study; follow-up; functional outcomes; functional restoration; healing; high reward; high risk; improved; innovation; instrument; instrumentation; male; mechanical load; men; pre-clinical; preservation; prevent; primary outcome; randomized, clinical trials; rehabilitation paradigm; rehabilitative care; repair model; repaired; secondary outcome; sex; tendon rupture; timeline; visual feedback

SUMMARY Achilles tendon ruptures have increased 10-fold in the last 3 decades but rehabilitation loading protocols remain generalized with unpredictable and generally poor outcomes. While clinical consensus exists supporting early tendon loading to promote healing, the loading magnitudes and frequencies that maximize functional outcomes remain unknown. This high-risk high-reward study will leverage an established small animal model to systematically determine whether precision rehabilitation loading mitigates deleterious muscle- tendon structural changes, thus preserving ankle function. To test the effects of daily active muscle loading, nerve stimulating cuffs will be surgically implanted on the tibial nerve. By stimulating the tibial nerve, precise muscle-tendon loads will be delivered daily to promote tendon healing and prevent muscle remodeling. In aim 1, animals will undergo simulated tendon rupture, surgical tendon repair, and immobilization followed by cage activity. Throughout immobilization, animals will receive daily muscle excitation profiles to stimulate active muscle contractions. These muscle contractions will be delivered below the tendon strain threshold to ensure that the active muscle contractions do not further damage the healing tendon. This timeline has direct translation to the recovery timeline that patients are prescribed following an Achilles tendon rupture. In aim 2, the effects of sex as a biologic variable will be tested by including equal numbers of male and female rats in each experimental group. The primary outcome of this study is active plantar flexor torque generate over the entire range of ankle motion. By calculating the total work done by the ankle, these experiments will provide the most rigorous evidence to date in support of precision rehabilitation. The secondary outcomes of this study are tendon elongation and muscle remodeling, which patient and computational experiments confirm are the mechanical mechanisms that govern ankle function. This study will be the first to identify precision rehabilitation loading profiles that preserve muscle-tendon structure and restore ankle function following Achilles tendon rupture and repair. Importantly, patients can generate prescribed ankle loading profiles when provided with visual feedback during calf strengthening activities. This direct translation to clinical care will shift the rehabilitation paradigm away from generalized loading to precision loading.

概括 过去 3 年来，跟腱断裂的数量增加了 10 倍，但康复负荷方案 仍然普遍存在，结果不可预测且普遍较差。虽然存在临床共识 支持早期肌腱负荷以促进愈合，最大限度地提高负荷幅度和频率 功能结果仍未知。这项高风险高回报的研究将利用一个已建立的小型研究机构 动物模型系统地确定精确康复负荷是否减轻有害的肌肉 肌腱结构改变，从而保留踝关节功能。为了测试日常主动肌肉负荷的效果， 神经刺激袖带将通过手术植入胫神经。通过刺激胫神经，精准 每天都会施加肌肉肌腱负荷，以促进肌腱愈合并防止肌肉重塑。瞄准目标 1、动物将进行模拟肌腱断裂、肌腱修复手术、固定和笼内固定 活动。在整个固定过程中，动物将收到每日肌肉兴奋曲线，以刺激活性 肌肉收缩。这些肌肉收缩将在肌腱应变阈值以下进行，以确保 主动肌肉收缩不会进一步损害正在愈合的肌腱。这个时间线有直接的 转化为跟腱断裂后患者的康复时间表。在目标 2 中， 将通过在实验中纳入相同数量的雄性和雌性大鼠来测试性别作为生物变量的影响 每个实验组。这项研究的主要结果是主动跖屈肌扭矩在 踝关节的整个运动范围。通过计算脚踝所做的总功，这些实验将提供 迄今为止支持精准康复的最严格证据。本研究的次要结果 是肌腱伸长和肌肉重塑，患者和计算实验证实这是 控制踝关节功能的机械机制。这项研究将是第一个确定精确度的研究 康复负荷曲线可保留肌肉肌腱结构并恢复踝关节功能 跟腱断裂和修复。重要的是，患者可以在以下情况下生成规定的踝关节负载曲线： 在小腿强化活动期间提供视觉反馈。这种直接转化为临床护理的方式将发生转变 康复模式从广义加载转向精确加载。