Anterior Cruciate Ligament Injury Clinical Trial
Official title:
Mechanical Perturbation Training for ACL Injury Prevention
A prospective trial will be used to evaluate the efficacy of prophylactic mechanical perturbation training program. 24 female athletes who are regular participants in activities that involve cutting, pivoting, jumping, and lateral movements prior to injury who range in age from 15-30 year are eligible. Using a prospective risk stratification design, female athletes with knee abduction moment (KAM) > 25.25 Nm from drop jump motion analysis will be classified as high KAM and will receive 12 sessions of mechanically-driven perturbation training and female athletes with KAM < 25.25 Nm from drop jump motion analysis will be classified as normal KAM and only participate in baseline performance testing, followed 6 weeks later by another session of drop jump motion analysis and performance testing.
Anterior cruciate ligament (ACL) injuries are prevalent in sports with female athletes at
particularly high risk. Female athletes have 2-4x higher risk of ACL injury compared to
their male counterparts in the same high-risk sports. Modifiable and non-modifiable risk
factors play a role in the high incidence of ACL injuries in female athletes. High knee
abduction moment (KAM), is a known modifiable risk factor for ACL injury risk. Female
athletes with a KAM greater than 25.25 Nm have been identified as at high risk for an ACL
injury. The ability to classify female athletes who are at a high risk for an ACL injury,
highlights the importance of identifying modifiable risk factors that can be readily
addressed by physical therapists and developing targeted treatments to potentially reduce
ACL injury risk while improving functional performance.
Neuromuscular training programs are treatments designed to help improve coordination,
strength, and control. Such training programs have been designed to alter biomechanical and
neuromuscular measures, in particular high KAM, in order to improve performance and function
and thereby reduce the risk of ACL injury. Neuromuscular training programs involving
plyometric exercises can reduce dynamic lower extremity valgus and limb-to-limb asymmetries
in healthy female athletes. Despite the reductions in injury rates seen with performance of
neuromuscular training programs, incidence of ACL injuries is remains higher than
acceptable. Novel training methods are currently in development to optimize these current
ACL injury prevention programs. As unanticipated perturbations may contribute to ACL injury
risk, incorporating a mechanical platform device that provides unanticipated surface
compliance changes (i.e. the floor lowering down below a subject's feet) into an ACL injury
prevention program has the potential to optimize knee biomechanics and neuromuscular
performance, including during unanticipated perturbations.
Mechanical perturbation has been advocated for as an effective training method to modify the
sensorimotor system and restore normal neuromuscular coordination through exposing the
subjects to controlled, progressive perturbations. Furthermore, mechanical perturbation has
the potential to improve dynamic postural stability and control, and enhance muscle
activation patterns. One advantage of mechanical perturbation devices is that they can be
utilized while performing a variety of dynamic tasks such as hopping and jumping compared to
static loading tasks such as standing and balancing activities. Dynamic tasks may place a
greater demand on the knee joint, promoting joint stability as the subject overcomes the
perturbation. Additionally, mechanical perturbation may allow physical therapists to
administer random perturbations at different phases of the activities (i.e. as the subject
is landing from a hop, or taking-off from a jump) that simulate real-life perturbations
which occur during different functional or sporting activities.
The goal of this study is to assess the effectiveness of an intensive neuromuscular training
program to reduce risk factors associated with ACL injury
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