Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Many of those with chronic ACL deficiency have evidence of knee OA years after ACL rupture. Weakness and instability experienced by those who do not compensate well for ACL deficiency (non-copers) independently lead to compensation strategies that could precipitate or worsen knee OA. These poor compensation strategies do not uniformly resolve after surgical reconstruction and those who undergo reconstruction also have an increased risk of developing knee OA. The overall goal of this work is to determine whether effective rehabilitation programs to dynamically stabilize the knee improve outcome and reduce maladaptations after ACL reconstruction in a population at great risk for the development of knee OA. Eighty individuals with ACL rupture who are scheduled for surgery will be randomly assigned to a group that includes a form of neuromuscular training called perturbation training, or a standard group. They will be evaluated before and after surgery using motion analysis and radiography, in vivo measures of kinematics, kinetics, tibial translation and EMG based models of joint compression will be used for comparison. This randomized trial is designed to demonstrate that, after preoperative rehabilitation that includes perturbation training, non-copers will: 1) demonstrate movement and muscle firing patterns that are characteristic of those with dynamic stability, 2) these changes will persist after reconstruction and 3) training induced changes in movement and muscle firing patterns will result in better functional outcomes after reconstruction. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACL's each year and undergo reconstructive surgery. More importantly, if pre-operative perturbation training can facilitate both improved patient outcomes and a reduction in maladaptions following reconstructive ACL surgery, these findings may have applications for individuals with an extensive range of knee injuries.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR048212-02
Application #
7054132
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Panagis, James S
Project Start
2005-04-15
Project End
2010-03-31
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
2
Fiscal Year
2006
Total Cost
$324,393
Indirect Cost
Name
University of Delaware
Department
Other Health Professions
Type
Other Domestic Higher Education
DUNS #
059007500
City
Newark
State
DE
Country
United States
Zip Code
19716
Wellsandt, Elizabeth; Failla, Mathew J; Snyder-Mackler, Lynn (2017) Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther 47:334-338
Capin, Jacob J; Behrns, William; Thatcher, Karen et al. (2017) On-Ice Return-to-Hockey Progression After Anterior Cruciate Ligament Reconstruction. J Orthop Sports Phys Ther 47:324-333
Wellsandt, Elizabeth; Khandha, Ashutosh; Manal, Kurt et al. (2017) Predictors of knee joint loading after anterior cruciate ligament reconstruction. J Orthop Res 35:651-656
Khandha, Ashutosh; Manal, Kurt; Wellsandt, Elizabeth et al. (2017) Gait mechanics in those with/without medial compartment knee osteoarthritis 5 years after anterior cruciate ligament reconstruction. J Orthop Res 35:625-633
Wellsandt, E; Zeni, J A; Axe, M J et al. (2017) Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury. Clin Biomech (Bristol, Avon) 50:63-69
Capin, Jacob J; Khandha, Ashutosh; Zarzycki, Ryan et al. (2017) Gait mechanics and second ACL rupture: Implications for delaying return-to-sport. J Orthop Res 35:1894-1901
Silvers-Granelli, Holly J; Bizzini, Mario; Arundale, Amelia et al. (2017) Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players? Clin Orthop Relat Res 475:2447-2455
Wellsandt, Elizabeth; Gardinier, Emily S; Manal, Kurt et al. (2016) Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Am J Sports Med 44:143-51
Di Stasi, Stephanie; Hartigan, Erin H; Snyder-Mackler, Lynn (2015) Sex-specific gait adaptations prior to and up to 6 months after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 45:207-14
Manal, K; Gardinier, E; Buchanan, T S et al. (2015) A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments. Osteoarthritis Cartilage 23:1107-11

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