Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes

针对女运动员 ACL 负荷机制的神经肌肉干预

• 批准号: 8309809
• 负责人: Timothy E Hewett
• 金额: $ 66.54万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8309809
• 关键词: Address; Anterior Cruciate Ligament; Biomechanics; Body Weight; Data; Degenerative polyarthritis; Double-Blind Method; Drops; Educational Intervention; Evidence based intervention; Exercise; Female; Goals; Health; Hip region structure; Injury; Intervention; Knee; Lateral; Leg; Limb structure; Link; Manufactured basketball; Medial; Motion; Positioning Attribute; Randomized Controlled Trials; Reaction; Relative (related person); Risk; Sensitivity and Specificity; Soccer; Specificity; Sports; Testing; Torque; Training; Training Programs; Validation; Women' s Group; Work; combinatorial; design; evidence base; foot; high risk; injured; ligament injury; male; neuromuscular; therapy design; vector

DESCRIPTION (provided by applicant): Females who participate in cutting and landing sports suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Fifty to 100 percent of ACL injured females will suffer osteoarthritis of the injured knee within one to two decades of the injury. External knee abduction moment (LOAD) predicts ACL injury with high sensitivity and specificity in female athletes. Control of lateral trunk motion (LTM) also predicts ACL injury with similar levels of sensitivity and specificity in female athletes. These predictors may be linked, as lateral positioning of the trunk can induce knee abduction load via both biomechanical and neuromuscular mechanisms. The mechanism of ACL injury in females most often includes high knee LOAD and high LTM, with the majority of body weight shifted over the injured limb and the foot positioned lateral to the body's center of mass. An unanticipated perturbation is also often a contributor to the injury mechanism. LTM may result in increased knee LOAD via lateral positioning and increased magnitude of the GRF vector ( GRFv) or by altered reactive hip adductor torque (HAdT). Our long-term objectives are to determine the mechanisms that increase ACL injury risk in female athletes and to develop neuromuscular training (NMT) interventions that specifically target these mechanisms. If the objectives of this proposal are achieved, an evidence-based NMT intervention will be developed and made available nationally that will effectively and efficiently reduce ACL injury risk in high-risk female athletes. The major goal of this proposal is to determine if increased LTM alters LOAD in female athletes. This application will test the central hypotheses that LTM increases knee LOAD and that NMT that is targeted toward increasing coronal plane control of trunk motion will decrease LOAD in females. Aim 1 is designed to determine the mechanisms by which trunk motion may increase knee LOAD in female athletes. Coronal plane control of the trunk (LTM) will be examined relative to GRFv, HAdT and knee LOAD. We will determine if increased LTM increases knee LOAD via biomechanical (increased GRFv) and/or neuromuscular (increased relative HAdT) mechanisms. The central hypothesis of Aim 1 is that increased LTM will increase knee LOAD in female athletes by increasing GRFv, by increasing HAdT or via a combination of these mechanisms during cutting and landing. We hypothesize that females with neither mechanism will have low knee LOAD, those with increased GRFv or HAdT will have moderate LOAD and those with increased GRFv and HAdT will have high knee LOAD. Aim 2 is designed to determine if NMT targeted to decreases coronal plane trunk motion (TNMT) will decrease both LTM and knee LOAD to a greater extent than sham/control training in a randomized controlled trial (RCT). The primary hypothesis of Aim 2 is that TNMT will decrease LTM and knee LOAD. Secondary hypotheses will test relationships between changes in LTM, GRFv, HAdT and LOAD with TNMT using Post-Hoc analysis. Neuromuscular Intervention Targeted to Mechanisms of ACL Load in Female Athletes. PUBLIC HEALTH RELEVANCE. Females who participate in cutting and landing sports like soccer and basketball suffer anterior cruciate ligament (ACL) injuries at a 2 to 10-fold greater rate than males participating in the same high-risk sports. Our previous work shows that lateral knee load and trunk motion can each independently increase ACL injury risk in female athletes. The major objectives of this proposal are to determine how lateral trunk motion increases knee load in female athletes who are at greater risk ACL injury and to develop exercise training programs that decrease trunk motion, knee load and ACL injury risk in these high-risk athletes.

描述（由申请人提供）：参加冲刺和落地运动的女性遭受前十字韧带 (ACL) 损伤的几率是参加相同高风险运动的男性的 2 至 10 倍。 50% 到 100% 的 ACL 受伤女性会在受伤后一到二十年内患上受伤膝盖的骨关节炎。膝关节外展力矩 (LOAD) 可以高灵敏度和特异性地预测女性运动员的 ACL 损伤。躯干横向运动 (LTM) 的控制也可以预测 ACL 损伤，在女性运动员中具有相似的敏感性和特异性。这些预测因素可能是相关的，因为躯干的侧向定位可以通过生物力学和神经肌肉机制诱导膝关节外展负荷。女性 ACL 损伤的机制通常包括高膝关节负荷和高 LTM，其中大部分体重转移到受伤肢体上，并且足部位于身体质心的侧面。意外的扰动通常也是造成损伤机制的一个因素。 LTM 可能会通过横向定位和增加 GRF 矢量 (GRFv) 的幅度或通过改变反应性髋内收肌扭矩 (HAdT) 导致膝关节负荷增加。我们的长期目标是确定增加女运动员 ACL 损伤风险的机制，并开发专门针对这些机制的神经肌肉训练 (NMT) 干预措施。如果该提案的目标实现，将开发并在全国范围内提供基于证据的 NMT 干预措施，这将有效且高效地降低高风险女运动员的 ACL 损伤风险。该提案的主要目标是确定增加 LTM 是否会改变女性运动员的负荷。该应用将测试以下中心假设：LTM 会增加膝盖负荷，而 NMT 旨在增加躯干运动的冠状面控制，从而减少女性的负荷。目标 1 旨在确定躯干运动可能增加女性运动员膝盖负荷的机制。将相对于 GRFv、HAdT 和膝关节负荷检查躯干冠状面控制 (LTM)。我们将确定增加的 LTM 是否会通过生物力学（增加 GRFv）和/或神经肌肉（增加相对 HAdT）机制来增加膝关节负荷。目标 1 的中心假设是，增加 LTM 将通过增加 GRFv、增加 HAdT 或通过在切入和着陆期间这些机制的组合来增加女性运动员的膝关节负荷。我们假设没有这两种机制的女性膝关节负荷较低，GRFv 或 HAdT 增加的女性膝关节负荷中等，GRFv 和 HAdT 增加的女性膝关节负荷较高。目标 2 旨在确定旨在减少冠状面躯干运动 (TNMT) 的 NMT 是否会比随机对照试验 (RCT) 中的假手术/对照训练更大程度地减少 LTM 和膝关节负荷。目标 2 的主要假设是 TNMT 将减少 LTM 和膝关节负荷。次要假设将使用事后分析来测试 LTM、GRFv、HAdT 和 LOAD 变化与 TNMT 之间的关系。针对女运动员 ACL 负荷机制的神经肌肉干预。 公共卫生相关性。 参加足球和篮球等切入和落地运动的女性遭受前十字韧带 (ACL) 损伤的几率是参加相同高风险运动的男性的 2 至 10 倍。我们之前的研究表明，膝关节侧向负荷和躯干运动可以分别独立地增加女性运动员 ACL 损伤的风险。该提案的主要目标是确定侧向躯干运动如何增加 ACL 损伤风险较高的女性运动员的膝盖负荷，并制定运动训练计划，降低这些高风险运动员的躯干运动、膝盖负荷和 ACL 损伤风险。