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Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects

Wordeman, Samuel Clayton
http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293

Abstract Details

2014, Doctor of Philosophy, Ohio State University, Biomedical Engineering.
Second anterior cruciate ligament (ACL) injury after ACL reconstruction occurs at reported rates ranging from 5 to 20 times greater than for primary injury, and results in significantly poorer patient outcomes. In athletes, the majority of second ACL injuries occur within the first two years of return to sport. Significant functional impairments and deficits in neuromuscular control are frequently reported up to two years post-reconstruction. Targeted neuromuscular training (NMT) alters high-risk biomechanics and reduces rates of primary ACL injury, but its efficacy in ACL-injured subjects is currently unknown. External loads during dynamic motion, specifically knee abduction moment (KAM), internal tibial rotation moment (ITR), and proximal anterior tibial shear force (ATS) increase ACL strain. These factors are reportedly influenced by modifiable and non-modifiable factors. Thorough determination of post-operative biomechanical impairments, modifiable and non-modifiable risk factors, and the effects of NMT on these factors will likely aid in eventual reduction of second ACL injury rates. The goals of this dissertation were: 1) Define the relationships between select modifiable and non-modifiable risk factors for second ACL injury, and high-risk biomechanics after ACL reconstruction. 2) Determine the clinical and biomechanical efficacy of NMT in ACL-reconstructed subjects, and 3) Model effects of NMT at the tissue-level using finite element (FE) modeling. We hypothesized that modifiable risk factors would be most strongly associated with KAM, a known predictor of primary injury. We also hypothesized that that NMT would significantly improve biomechanics and patient outcomes, and result in reduced finite element (FE) model-predicted ACL strain during landing. Thirteen ACL-reconstructed subjects (7 males, 6 females, 20.15±7.97 years) were enrolled in the NMT group and evaluated at 36.0±18.3 weeks post-operative, and were re-tested after participation in a 12 session NMT program at 46.6±17.4 weeks post-operative. 13 untrained, ACL-reconstructed controls (9 males, 4 females, 20.77±6.55 years) were tested 52.4±2.7 weeks post-operative and compared to trained subjects. Test measures included instrumented knee laxity, medial and lateral tibial plateau slope (MTPS and LTPS, respectively) measured on MRI, isokinetic strength, 3D biomechanics, clinical performance measures, and patient-reported outcomes instruments. Previously-developed and validated sex-specific finite element (FE) models were used to predict changes in ACL strain from pre- to post-training. Significant relationships between LTPS and KAM (R2=0.29, p=0.005), sex, MTPS, and ATS (R2=0.422, p=0.004), and laxity, MTPS, LTPS, and peak hip abduction moment and ITR (R2=0.78, p<0.001) were identified. Pre-training task-dependent asymmetries in hip flexion and frontal plane excursion during unilateral and bilateral landing tasks were resolved with training. Trained subjects demonstrated significant increases in peak knee flexion after training, and greater peak knee flexion and knee flexion range of motion compared to controls. Static FE simulations of in vivo biomechanics during bilateral landing did not show a main effect of training on ACL strain, but demonstrated significant reduction in ACL strain in females after training. Clinical measures, strength, and patient-reported outcome did not differ between trained and untrained subjects.
Timothy Hewett, PhD (Advisor)
Alan Litsky, MD, ScD (Committee Member)
Michael Knopp, MD, PhD (Committee Member)
259 p.
Biomechanics; Biomedical Engineering; Engineering; Health Sciences; Mechanics; Physical Education
anterior cruciate ligament, neuromuscular training, injury, prevention, outcomes, tibial plateau slope, knee laxity, risk factor, ACL, knee injury, knee biomechanics, biomechanics, injury biomechanics, orthopaedics, ACL reconstruction

Recommended Citations

Citations

  • Wordeman, S. C. (2014). Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293

    APA Style (7th edition)

  • Wordeman, Samuel. Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects. 2014. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293.

    MLA Style (8th edition)

  • Wordeman, Samuel. "Effects of Neuromuscular Training in Anterior Cruciate Ligament-Reconstructed Subjects." Doctoral dissertation, Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1410446293

    Chicago Manual of Style (17th edition)

osu1410446293
1,153
© 2014, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.