Traumatic and debilitating anterior cruciate ligament (ACL) injuries occur at a 2- to 10-fold greater rate in female than male athletes, and 50-100% of females develop knee osteoarthritis within 12-20 years of initial injury. The National Public Health Agenda for Osteoarthritis recommends expanding and refining evidence- based prevention of ACL injury to reduce this burden. We have identified modifiable risk factors that predict ACL injury in young female athletes. Our lab-based neuromuscular training targets modifiable risk factors and shows statistical efficacy in high-risk athletes, but a meaningful risk re-categorization to low-risk has not been achieved. Standard interventions may be inefficient for biomechanical adaptation, susceptible to non- compliance, and limited in translation to injury risk reductions; current approaches have not yet decelerated national ACL injury rates in young female athletes. The key gap in knowledge is how to deliver objective, individualized, analytic feedback efficiently and effectively for injury prevention training. The overall objective of this proposal is to implement and test innovative augmented neuromuscular training (aNMT) methods to enhance sensorimotor learning and more effectively reduce biomechanical risk factors for ACL injury. aNMT biofeedback integrates biomechanics screening with portable augmented reality glasses to display real-time feedback, which maps complex biomechanical variables onto simple visual stimuli that athletes intuitively control via their own movements. Our published and new preliminary data on aNMT demonstrate our proficiency in implementing this technology and the efficacy of the approach to efficiently induce desired training adaptations. The data support this proposal's central hypothesis: Sensorimotor biofeedback will improve localized joint mechanics and reduce global injury risk in evidence-based measures collected in laboratory tasks and in realistic, sport-specific virtual reality scenarios. Once the objectives of this application are achieved, we expect to both optimize the efficiency and enhance the efficacy of feedback for personalized and targeted injury prevention, and establish the potential for enhanced sensorimotor adaptions from aNMT to translate to the field of play. The removal of barriers to feedback interventions (e.g., the need for qualified instructors who provide subjective, possibly erroneous or unclear feedback) via real-time automated, implicit, and analytic-driven biofeedback could revolutionize ACL injury prevention. The positive impact of such innovative strategies will be enhanced delivery of biofeedback with increased potential for sport transfer. This contribution will be significant for ACL injury prevention and associated long-term sequelae in young females. It will also likely benefit injury prevention strategies for males, enhance motor development programs for children, and impact rehabilitation strategies in orthopedic clinical practice.

Public Health Relevance

The proposed research is relevant to public health because discovery of successful knee injury prevention techniques will lead to fewer young women who sustain knee injuries; this is currently a major long term individual and public health problem in the United States. The project is relevant to NIH's mission because the knowledge gained will be used to optimize prevention strategies that will enhance health and reduce the burdens of knee injuries that afflict women disproportionately compared to males.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01AR067997-01A1
Application #
9025996
Study Section
Arthritis and Musculoskeletal and Skin Diseases Clinical Trials Review Committee (AMSC)
Program Officer
Washabaugh, Charles H
Project Start
2016-08-01
Project End
2021-07-31
Budget Start
2016-08-01
Budget End
2017-07-31
Support Year
1
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Cincinnati Children's Hospital Medical Center
Department
Type
DUNS #
071284913
City
Cincinnati
State
OH
Country
United States
Zip Code
45229
Hewett, Timothy E; Ford, Kevin R; Xu, Yingying Y et al. (2017) Effectiveness of Neuromuscular Training Based on the Neuromuscular Risk Profile. Am J Sports Med 45:2142-2147
Sugimoto, Dai; Mattacola, Carl G; Bush, Heather M et al. (2017) Preventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates. J Athl Train 52:58-64
Bates, Nathaniel A; McPherson, April L; Nesbitt, Rebecca J et al. (2017) Robotic simulation of identical athletic-task kinematics on cadaveric limbs exhibits a lack of differences in knee mechanics between contralateral pairs. J Biomech 53:36-44
Montalvo, Alicia M; Shaefer, Hilary; Rodriguez, Belinda et al. (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. J Sports Sci Med 16:53-59
Grooms, Dustin R; Myer, Gregory D (2017) Upgraded hardware?What about the software? Brain updates for return to play following ACL reconstruction. Br J Sports Med 51:418-419
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Hewett, Timothy E; Myer, Gregory D; Ford, Kevin R et al. (2016) Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res 34:1843-1855
Hewett, Timothy E; Ford, Kevin R; Xu, Yingying Y et al. (2016) Utilization of ACL Injury Biomechanical and Neuromuscular Risk Profile Analysis to Determine the Effectiveness of Neuromuscular Training. Am J Sports Med 44:3146-3151
Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A et al. (2016) The scientific foundations and associated injury risks of early soccer specialisation. J Sports Sci 34:2295-2302
Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A et al. (2016) Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 46:1059-66

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