Effects of anterior cruciate ligament reconstruction on the association between quadriceps muscle dynamics, knee joint biomechanics, and articular cartilage loading during walking

前交叉韧带重建对行走时股四头肌动力学、膝关节生物力学和关节软骨负荷之间关系的影响

基本信息

批准号：
10403951
负责人：
Amanda Munsch
金额：
$ 3.85万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2023-04-30
项目状态：
已结题

项目摘要

PROJECT SUMMARY Individuals with anterior cruciate ligament reconstruction (ACLr) walk with smaller than typical peak knee extensor moments (pKEM) and diminished knee flexion excursion during the weight acceptance phase of walking. These deficits in voluntary quadriceps activation are considered critical in the biomechanical cascade underlying disproportionally high rates of post-traumatic osteoarthritis (PTOA) in individuals with ACLr. It has been suggested that changes in gait biomechanics at the knee joint can shift articular contact forces to regions not conditioned to loading, particularly when the event allows little time for cartilage adaptation. The gait changes observed in individuals with ACLr likely result from a combination of weakness and central inhibition during functional activities and must be addressed with a novel rehabilitation strategy because quadriceps strengthening alone appears unable to return gait biomechanics to uninjured values. This will be the first study to establish mechanistic links between quadriceps kinematics, deficits in voluntary force production, and maladaptive cartilage loading patterns in individuals with ACLr. The proposed research will use a multi-scale approach with novel applications of gait biofeedback, in vivo ultrasound imaging, and cutting-edge knee joint simulations. Through our pilot in vivo ultrasound testing, we observe a fundamentally different behavior in quadriceps activation between ACLr and uninjured controls. Differences in muscle fascicle length change may be a functional consequence of quadriceps dysfunction relevant to altered knee loading. The proposed research builds upon this concept to evaluate quadriceps contractile dynamics during tasks requiring different functional demands to strategically assess the effects of modulating pKEM in individuals with ACLr. Furthermore, the proposed research will evaluate how systematic changes in quadriceps activation and knee joint biomechanics cued via biofeedback or walking speed affect cartilage contact forces. The proposed research will have immediate impact on our understanding of the contributions of quadriceps activation deficits in PTOA development following ACLr.

项目概要进行前十字韧带重建 (ACLr) 的个体行走时膝关节峰值小于典型膝峰伸肌力矩 (pKEM) 和在重量接受阶段减少膝关节屈曲偏移步行。这些自愿股四头肌激活的缺陷被认为在生物力学级联中至关重要 ACLr 患者的创伤后骨关节炎 (PTOA) 发病率极高。它有有人认为膝关节步态生物力学的变化可以将关节接触力转移到区域不适应负载，特别是当活动几乎没有时间让软骨适应时。步态在患有 ACLr 的个体中观察到的变化可能是由无力和中枢抑制共同导致的在功能活动期间，必须采用新的康复策略来解决，因为股四头肌仅加强力量似乎无法使步态生物力学恢复到未受伤的值。这将是第一项研究建立股四头肌运动学、自愿力产生的缺陷和 ACLr 患者的适应不良软骨负荷模式。拟议的研究将使用多尺度步态生物反馈、体内超声成像和尖端膝关节的新颖应用的方法模拟。通过我们的体内超声试验，我们观察到了根本不同的行为 ACLr 和未受伤对照之间的股四头肌激活。肌束长度变化的差异可能是与膝关节负荷改变相关的股四头肌功能障碍的功能结果。拟议的研究建立在这个概念的基础上，在需要不同功能的任务中评估股四头肌的收缩动力学需要战略性地评估调节 pKEM 对 ACLr 患者的影响。此外，拟议的研究将评估股四头肌激活和膝关节生物力学的系统变化通过生物反馈或步行速度提示影响软骨接触力。拟议的研究将立即产生对我们理解股四头肌激活缺陷在 PTOA 发育中的贡献的影响遵循 ACLr。