The overall goal of this work is to continue to examine the differential response to anterior cruciate ligament (ACL) rupture. Although ACL reconstructive surgery has had reasonable success, it is not clear why these patients are more likely than uninjured subjects to develop osteoarthritis (OA) in later years. Based on the results of our first period of funding, we believe this is due to altered muscle morphology and activation. The changes in morphology, which can be measured using imaging techniques, lead to changes in muscle paths, muscle moment arms, and muscle volumes, which reduce force generating capacities in muscles. Such changes occur in selective muscles following reconstructive surgery. The changes in neural activation can be measured using EMGs, and result in different distributions of forces within the knee, which may lead to OA. In this proposal, we plan to use MRI and biomechanical modeling to examine ACL injured knees before and after reconstructive surgery.
The aim of this study is to characterize changes in (1) muscle/tendon morphology, (2) extensor and flexor strength, and (3) joint stabilization function, after post-rupture surgical reconstruction of ACL using bone-patellar tendon-bone autograft (BPTB), and quadruple-bundled semitendinosus gracilis (QSTG) autografts. We hypothesize that the morphology, activation and forces in the muscles about the knees will be different in the ACL reconstructed knees compared to unimpaired knees. Recovery from ACL injury is a major health problem, affecting over 80,000 Americans a year. Better understanding of the recovery from this surgery may reduce future incidents of OA in these patients.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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Skeletal Biology Structure and Regeneration Study Section (SBSR)
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Lester, Gayle E
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University of Delaware
Biomedical Engineering
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United States
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Wellsandt, Elizabeth; Failla, Matthew J; Axe, Michael J et al. (2018) Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury? Am J Sports Med 46:2103-2112
Capin, Jacob J; Khandha, Ashutosh; Zarzycki, Ryan et al. (2018) Gait mechanics and tibiofemoral loading in men of the ACL-SPORTS randomized control trial. J Orthop Res 36:2364-2372
Lanier, Amelia S; Knarr, Brian A; Stergiou, Nicholas et al. (2018) A Novel and Safe Approach to Simulate Cutting Movements Using Ground Reaction Forces. Sensors (Basel) 18:
Khandha, Ashutosh; Manal, Kurt; Capin, Jacob et al. (2018) High muscle co-contraction does not result in high joint forces during gait in anterior cruciate ligament deficient knees. J Orthop Res :
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, 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
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Gardinier, Emily S; Di Stasi, Stephanie; Manal, Kurt et al. (2014) Knee contact force asymmetries in patients who failed return-to-sport readiness criteria 6 months after anterior cruciate ligament reconstruction. Am J Sports Med 42:2917-25
Macleod, Toran D; Snyder-Mackler, Lynn; Buchanan, Thomas S (2014) Differences in neuromuscular control and quadriceps morphology between potential copers and noncopers following anterior cruciate ligament injury. J Orthop Sports Phys Ther 44:76-84

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