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 在过去的三十年中 保持不可预测的且总体上较差的结果。而存在临床共识 支撑早期肌腱负荷以促进愈合，加载幅度和最大化的频率 功能结果仍然未知。这项高风险的高回报研究将利用已建立的小型 动物模型系统地确定是否要恢复精确的康复是否会减轻有害的肌肉 - 肌腱结构变化，从而保留踝关节功能。为了测试每日活跃肌肉负荷的影响， 神经刺激的袖口将通过手术植入胫骨神经。通过刺激胫骨神经，精确 肌肉刺激载荷将每天递送，以促进肌腱愈合并防止肌肉重塑。目标 1，动物将经历模拟的肌腱破裂，手术肌腱修复和固定，然后进行笼子 活动。在整个固定化过程中，动物将每天接收肌肉激发曲线以刺激主动 肌肉收缩。这些肌肉收缩将在肌腱应变阈值以下传递 活跃的肌肉收缩不会进一步损害愈合肌腱。这个时间表有直接 转换为恢复时间表，即在致命肌肌腱破裂后开处方患者。在AIM 2中， 性别作为生物变量的影响将通过在中包括等量的男性和雌性大鼠来测试 每个实验组。这项研究的主要结果是在 整个踝运动范围。通过计算踝关节完成的总工作，这些实验将提供 迄今为止，最严格的证据支持精确康复。这项研究的次要结果 是肌腱伸长和肌肉重塑，患者和计算实验证实的是 控制踝关节功能的机械机制。这项研究将是第一个识别精度的研究 康复负载轮廓可保留肌肉刺结构并恢复脚踝功能 跟腱破裂和修复。重要的是，当患者可以在 在加强小腿加强活动期间提供视觉反馈。直接转化为临床护理将改变 康复范式从广义载荷到精确载荷。