The rationale for this application is to allow Dr. Riann Palmieri-Smith to receive both the didactic training and practical research experience necessary for her evolution into an independent clinical research scientist. This award will provide her with an opportunity to complete coursework in the areas of biomechanics and clinical research design. Dr. Palmieri-Smith will conduct clinical research, under the direction of Drs. Ashton-Miller, Sowers, and Wojtys examining the impact of quadriceps inhibition on knee mechanics and will also examine the feasibility of introducing neuromuscular electrical stimulation (NMES) as an adjunct to ACL rehabilitation. Building on the experience gathered during the period of this award, Dr. Palmieri-Smith will use the information she obtains from mechanistic, laboratory-based studies to develop and test clinical interventions that can improve the neuromuscular and functional recovery of persons following traumatic knee joint injury and those with osteoarthritis. The proposed research will determine the magnitude of quadriceps inhibition necessary to result in biomechanical, functional, and neuromuscular adaptations, and the feasibility of introducing NMES, an intervention capable of restoring quadriceps activation, in rehabilitation post-ACL reconstruction to restore normal mechanics. The burst superimposition technique will be utilized in subsets of ACL reconstructed patients to estimate quadriceps inhibition prior to and following ACL reconstruction and prior to and following NMES. Mechanics will be examined during a onelegged forward hop.

Public Health Relevance

Quadriceps inhibition is present following ACL injury and reconstruction and often persists for years following repair and its consequences remain elusive. Our work will allow for a better understanding of how muscle dysfunction impacts joint protective mechanisms. Introducing NMES as an adjunct to ACL rehabilitation may promote sustained improvements in quadriceps activation thereby restoring lower extremity mechanics and potentially reducing the incidence of post-traumatic osteoarthritis. This knowledge will aid clinicians in designing appropriate rehabilitation protocols and return to play guidelines that will prevent future injury and joint degeneration.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08AR053152-05
Application #
8230686
Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Panagis, James S
Project Start
2008-04-18
Project End
2013-12-31
Budget Start
2012-04-01
Budget End
2013-12-31
Support Year
5
Fiscal Year
2012
Total Cost
$126,900
Indirect Cost
$9,400
Name
University of Michigan Ann Arbor
Department
None
Type
Other Domestic Higher Education
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Thomas, Abbey C; Wojtys, Edward M; Brandon, Catherine et al. (2016) Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction. J Sci Med Sport 19:7-11
Lepley, Lindsey K; Palmieri-Smith, Riann M (2016) Pre-operative quadriceps activation is related to post-operative activation, not strength, in patients post-ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 24:236-46
Palmieri-Smith, Riann M; Lepley, Lindsey K (2015) Quadriceps Strength Asymmetry After Anterior Cruciate Ligament Reconstruction Alters Knee Joint Biomechanics and Functional Performance at Time of Return to Activity. Am J Sports Med 43:1662-9
Lepley, Lindsey K; Wojtys, Edward M; Palmieri-Smith, Riann M (2015) Does concomitant meniscectomy or meniscal repair affect the recovery of quadriceps function post-ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 23:2756-61
Lepley, Lindsey K; Palmieri-Smith, Riann M (2015) Quadriceps Strength, Muscle Activation Failure, and Patient-Reported Function at the Time of Return to Activity in Patients Following Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study. J Orthop Sports Phys Ther 45:1017-25
Lepley, Lindsey K; Wojtys, Edward M; Palmieri-Smith, Riann M (2015) Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction. Knee 22:270-7
Lepley, Lindsey K; Wojtys, Edward M; Palmieri-Smith, Riann M (2015) Combination of eccentric exercise and neuromuscular electrical stimulation to improve biomechanical limb symmetry after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 30:738-47
Thomas, Abbey C; Lepley, Lindsey K; Wojtys, Edward M et al. (2015) Effects of Neuromuscular Fatigue on Quadriceps Strength and Activation and Knee Biomechanics in Individuals Post-Anterior Cruciate Ligament Reconstruction and Healthy Adults. J Orthop Sports Phys Ther 45:1042-50
Lepley, Lindsey K; Thomas, Abbey C; McLean, Scott G et al. (2013) Fatigue's lack of effect on thigh-muscle activity in anterior cruciate ligament-reconstructed patients during a dynamic-landing task. J Sport Rehabil 22:83-92