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 #
5R01AR048212-05
Application #
7586792
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Panagis, James S
Project Start
2005-04-15
Project End
2011-03-31
Budget Start
2009-04-01
Budget End
2011-03-31
Support Year
5
Fiscal Year
2009
Total Cost
$303,996
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
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
Arundale, Amelia J H; Capin, Jacob J; Zarzycki, Ryan et al. (2018) Functional and Patient-Reported Outcomes Improve Over the Course of Rehabilitation: A Secondary Analysis of the ACL-SPORTS Trial. Sports Health 10:441-452
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 :
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
Capin, Jacob J; Khandha, Ashutosh; Zarzycki, Ryan et al. (2018) Gait Mechanics After ACL Reconstruction Differ According to Medial Meniscal Treatment. J Bone Joint Surg Am 100:1209-1216
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
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
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

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