Anterior cruciate ligament (ACL) injuries are a significant problem for athletes, and women in particular. Both surgical and non-surgical treatment options exist, with the ultimate goal of regaining joint stability, knee kinematics, and quadriceps strength compared to the uninjured contralateral limb to allow full return of function and activity level and to prevent additional injury to the cartilage and the meniscus in the knee which might lead to an increased likelihood of osteoarthritis (OA). Published research has demonstrated clinically relevant effects of perturbation of support surface training for both ACL-deficient and ACL-reconstructed populations for improving dynamic knee stability, particularly in females. The clinically available methods of delivering the desired perturbations are currently limited to static balance boards that are manually pushed or pulled by the physical therapist. These perturbations may not simulate real-life perturbations that would occur during walking or running. The Principal Objective of this Fast Track SBIR project is to develop and validate a cost-effective commercial product, ActiveStep-Sport"""""""", for providing task-specific, neuromuscular, dynamic perturbation training to improve outcomes for both conservative and surgical treatment of ACL injury (ACL), particularly in young athletes and women.

Public Health Relevance

The proposed ActiveStep-Sport system provides the enabling technology for large-scale application of clinically relevant perturbation of support surface training for anterior cruciate ligament (ACL) injury rehablitiation. Approximately 100,000-175,000 ACL reconstructions performed annually in the US annually, with females significantly more likely to suffer an ACL rupture than males. Perturbation training in certain ACL injured populations has been shown to reduce episodes of giving way and to reduce abnormal knee kinematics, both of which often lead to an inability to regain functional levels of sports participation and increase the potential for developing knee osteoarthritis. Use of perturbation training is hypothesized to improve knee kinematics compared to strengthening alone, and to improve outcomes for ACL rehabilitation. The technology developed here represents a translation of validated laboratory-based research methodology to a system more suited for widespread clinical use. If technically and economically feasible, ActiveStep-Sport will help reduce the overall health care costs associated with the treatment and rehabilitation of ACL injuries and the onset of osteoarthritis.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Small Business Innovation Research Grants (SBIR) - Phase II (R44)
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Special Emphasis Panel (ZRG1-MOSS-F (15))
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Shinowara, Nancy
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Simbex, LLC
United States
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Silvers-Granelli, Holly J; Bizzini, Mario; Arundale, Amelia et al. (2018) Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players. Knee Surg Sports Traumatol Arthrosc 26:1975-1983
Nawasreh, Zakariya; Logerstedt, David; Marmon, Adam et al. (2018) Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture. J Sport Rehabil :1-32
Arundale, Amelia J H (2018) Keeping athletes on the field: preventing primary and secondary ACL injuries. Br J Sports Med 52:618-619
Arundale, Amelia Joanna Hanford; Silvers-Granelli, Holly Jacinda; Snyder-Mackler, Lynn (2018) Career Length and Injury Incidence After Anterior Cruciate Ligament Reconstruction in Major League Soccer Players. Orthop J Sports Med 6:2325967117750825
Nawasreh, Zakariya; Failla, Mathew; Marmon, Adam et al. (2018) Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture. Gait Posture 64:43-49
Nawasreh, Zakariya; Logerstedt, David; Failla, Mathew et al. (2018) No difference between mechanical perturbation training with compliant surface and manual perturbation training on knee functional performance after ACL rupture. J Orthop Res 36:1391-1397
Arundale, Amelia J H; Silvers-Granelli, Holly J; Marmon, Adam et al. (2018) Changes in biomechanical knee injury risk factors across two collegiate soccer seasons using the 11+ prevention program. Scand J Med Sci Sports 28:2592-2603