The overall goal of this project is to prevent risk of second anterior cruciate ligament (ACL) injury in vulnerable populations, which consist of young, active men, women, girls and boys. Specifically, we propose to 1) stratify patients into risk groups for second ACL injury, 2) determine the effects of differential treatment on biomechanical measures of ACL injury risk and return to sport readiness after reconstruction (ACLR). Additionally, we will begin the development of a clinical algorithm that will classify patient risk for second ACL injury to facilitate the translation of findings from the laboratory into the clinic. Differential treatment will include a home only program, a standard clinical rehabilitation program, and a novel targeted neuromuscular training program designed to augment core and hip strength as well as promote optimum, low risk movement strategies in both lower extremities. Highly active men and women between the ages of 14 ? 24 years who have sustained an acute, isolated primary ACL injury will be recruited for study participation. As patients enter their final phase of rehabilitation after surgery they will undergo testing that includes self-reported function, performance of drop jumps, hop testing, strength assessment, and balance assessment. After testing, patients will be randomized into one of the three intervention groups for a six-week, twelve-session training program. After completion of training the patients will repeat the same battery of tests. To determine relative risk for second ACL injury, cluster-analysis statistical testing will be performed. Differences between risk-groups will be validated using the frontal plane hip and knee motions, which will be used as surrogates for ACL injury. Repeated measures ANOVA testing will be conducted to identify differences before and after testing to determine the effectiveness of each intervention program on clinical performance and biomechanical measures. Results from this proposed work will allow us to prospectively identify high risk patients who are the most appropriate recipients of enhanced treatment, including targeted neuromuscular training, which may reduce second ACL risk. Patients with lower-risk for second ACL injury may achieve optimum benefits from less intensive intervention. Thus, differential interventions may reduce the risk of a subsequent injury, enhance the quality of life for a significant cohort of young adults, and yield a more efficacious delivery of health care resources after ACLR.

Public Health Relevance

The overall goal of this project is to reduce risk of second anterior cruciate ligament (ACL) injury in vulnerable populations (active athletes between 14 ? 24 years old) through the identification of relative injury risk groups based on subject-specific movement patterns prior to second injury, as well as through the determination of effect for differential rehabilitation protocols following initial ACL reconstruction and prior to return to sport. As nearly one-third of athletes who have a primary ACL injury and return to sport will experience a secondary injury, results from the proposed work will allow us to prospectively identify high risk patients who are the most appropriate recipients of enhanced treatment, including targeted training, which may reduce the risk of second ACL injury. Secondary ACL injury has the potential to end athletic careers, promote the development of osteoarthritis, and have debilitating effects on quality of life. Hence, the information gathered in this investigation will offer ACL injured athletes the optimal potential to reduce or potentially prevent these negative health effects before they are initiated.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
Project #
Application #
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Washabaugh, Charles H
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Mayo Clinic, Rochester
United States
Zip Code
Nagai, Takashi; Schilaty, Nathan D; Strauss, Jeffrey D et al. (2018) Analysis of Lower Extremity Proprioception for Anterior Cruciate Ligament Injury Prevention: Current Opinion. Sports Med 48:1303-1309
Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T et al. (2018) The influence of internal and external tibial rotation offsets on knee joint and ligament biomechanics during simulated athletic tasks. Clin Biomech (Bristol, Avon) 52:109-116
Nagai, Takashi; Bates, Nathaniel A; Hewett, Timothy E et al. (2018) Effects of localized vibration on knee joint position sense in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 55:40-44
Krill, Matthew L; Nagelli, Christopher; Borchers, James et al. (2018) Effect of Concussions on Lower Extremity Injury Rates at a Division I Collegiate Football Program. Orthop J Sports Med 6:2325967118790552
McPherson, April L; Bates, Nathanial A; Schilaty, Nathan D et al. (2018) Ligament Strain Response Between Lower Extremity Contralateral Pairs During In Vitro Landing Simulation. Orthop J Sports Med 6:2325967118765978
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
Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T et al. (2017) Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro. Clin Orthop Relat Res 475:2385-2396
Nagelli, Christopher V; Hewett, Timothy E (2017) Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations. Sports Med 47:221-232
Willigenburg, Nienke; Hewett, Timothy E (2017) Performance on the Functional Movement Screen Is Related to Hop Performance But Not to Hip and Knee Strength in Collegiate Football Players. Clin J Sport Med 27:119-126

Showing the most recent 10 out of 130 publications