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Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control

Nagelli, Christopher
http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928

Abstract Details

2017, Doctor of Philosophy, Ohio State University, Biomedical Engineering.
The anterior cruciate ligament (ACL) is one of four major ligaments that passively stabilize the knee joint. One of the primary functions of the ACL is to prevent excess anterior tibial translation relative to the femur, but the ACL also includes a sensorimotor reflex between the ligament and the muscles surrounding the knee. Early studies have noted that once the ACL is stimulated it elicits a motor response from the quadriceps and hamstring muscles. Injuries to the ACL occur nearly at a rate of 150,000 annually in the United States, with a disproportionately greater incidence in young, active athletes. The clinical standard of care for athletes who desire to return to pre-injury level of activity is restoring passive stability through ACL reconstruction (ACLR), but some resort to alternative, non-operative treatments and modify their activity level. The evidence in the literature indicates that following ACL injury, regardless of electing operative or non-operative treatment, athletes are less likely to resume pre-injury level of activity, are at a significantly greater risk of further knee injury than their uninjured counterpart, and rapidly progress to radiographic, knee osteoarthritis as early as 10-20 years after injury. These poor outcomes are associated with abnormal knee joint function that persists following ACL injury. The loss of ACL-sensorimotor function is implicated in knee dysfunction following ACL injury, and this prevailing deficit is not addressed by the current treatment options. In addition, the impact of losing ACL sensorimotor function is confounded with structural loss of the ligament. This prevents the full characterization of knee dysfunction following ACL injuries and may lead to clinical treatments which have limited efficacy. Therefore, the aims of this dissertation are to: 1) Determine the impact of ACL sensory loss on knee joint function and health in pre-clinical animal model, 2) Determine the effects of temporary altering neuro-sensory feedback on ambulatory biomechanics in ACLR patients, and 3a) Quantify the efficacy of a neuromuscular training program to improve hip and knee sensorimotor control in ACLR and 3b) Determine if neuromuscular training can recover normative sensorimotor control of the knee. We hypothesized that altered sensorimotor function is a significant contributor to joint dysfunction and health following ACL injury. Secondly, we hypothesized that neuromuscular training is a clinically viable tool to restore normative sensorimotor control of the hip and knee joint following ACLR. In order to test the hypotheses, a combination of basic science and clinical intervention studies were conducted. We developed an ACL-denervated preclinical, animal model to isolate the impact of ACL sensory function on joint function and health. Over the course of 12 weeks, we compared clinically relevant measures of joint function with ACL-transected and whole-joint denervated groups. At week 12, these same groups were sacrificed for arthroscopic and histologic assessment of the joint tissue. In addition, we conducted a prospective, randomized controlled trial to understand the effect of a femoral nerve block on gait mechanics in ACLR patients. Patients were randomized into either a nerve block or control group and gait analysis was assessed 6- and 12-weeks after ACLR. Finally, athletes with and without ACLR athletes participated in a 12-session neuromuscular training program. Baseline and post-training biomechanics testing was conducted to elucidate the effect of neuromuscular training in both groups. The results of studies indicate sensorimotor loss from ACL-injury is a significant contributor to joint dysfunction and health following ACL injury and neuromuscular training is a clinical tool that can restore normative sensorimotor function as measured by landing kinematics and kinetics. The primary aim of the dissertation demonstrated that the ACL-denervated model compared similarly to the ACL-transected model in measures of joint function and health. Secondly, the patients receiving a femoral nerve block demonstrated significantly more truncated hip kinematics during gait compared to the control group. Finally, the neuromuscular training significantly improved hip and knee kinematics and kinetics in ACLR athletes, and the ACLR and uninjured athletes demonstrated comparable biomechanics when assessed after completing neuromuscular training.
Timothy Hewett, PhD (Advisor)
Litsky Alan , MD, ScD (Committee Member)
Di Stasi Stephanie, PT, PhD (Committee Member)
318 p.
Biomechanics; Biomedical Engineering; Biomedical Research; Sports Medicine
Anterior Cruciate Ligament, ACL Reconstruction, Sensorimotor, Sports Medicine, Orthopedics, Biomechanics, Knee, Injury Prevention

Recommended Citations

Citations

  • Nagelli, C. (2017). Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928

    APA Style (7th edition)

  • Nagelli, Christopher. Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control. 2017. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928.

    MLA Style (8th edition)

  • Nagelli, Christopher. "Sensorimotor Contribution to Joint Dysfunction following Anterior Cruciate Ligament Injury and Neuromuscular Training as a Clinical Tool to Recover Sensorimotor Control." Doctoral dissertation, Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1500287443874928

    Chicago Manual of Style (17th edition)

osu1500287443874928
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This open access ETD is published by The Ohio State University and OhioLINK.