Can Neuromuscular Training Alter Movement Patterns
Condition: Acute Injury of Anterior Cruciate Ligament
MeSH terms: Anterior Cruciate Ligament Injuries
Study type: Interventional

Summary: 
      A prospective randomized controlled trial will be used to evaluate the efficacy of
      post-operative perturbation training. 80 patients who were regular participants in activities
      that involve cutting, pivoting, jumping, and lateral movements prior to injury who range in
      age from 13-55 at the time of injury are eligible. All eligible subjects must undergo primary
      anterior cruciate ligament reconstruction. Using a prospective randomized design, 40 subjects
      who will be block randomized by sex to 40 patients who will receive 10 sessions of
      post-operative perturbation training in addition to standard agility and return to activity
      progression and forty who receive only standard agility and return to activity progression.
      Post-operative perturbation training will be initiated when the athlete is at least 12 weeks
      post-anterior cruciate ligament reconstruction, has full range of motion and achieves 80%
      quadriceps strength symmetry, the criteria we currently use for beginning return to activity
      progression.
    

Detailed description: 
      For many years, our laboratory has been examining the functional capabilities and movement
      strategies of individuals who sustain anterior cruciate ligament injuries of the knee. Using
      a battery of clinical tests and measures with these athletes, we have learned that not all of
      these individuals respond similarly to injury. Some athletes, called potential copers,
      experience a high level of function after their injury. Rehabilitation that involves
      specialized training called perturbation training allows the majority of potential copers to
      be successful in returning to sports in the short-term. Non-copers, however, are a group of
      anterior cruciate ligament-injured athletes with poor knee stability during daily activities.
      The capability of these individuals to return to sport is limited, and anterior cruciate
      ligament reconstruction is typically recommended.

      Over the last five years, we have begun to investigate the effects of perturbation training
      on non-copers. Non-copers represent the majority of anterior cruciate ligament-injured
      athletes, and they are of great interest not only because of their distinct functional
      limitations, but also the large variability within this group. Abnormal movement patterns are
      common following anterior cruciate ligament injury, but strategies differ between potential
      copers and non-copers. During an activity as basic as walking, non-copers reduce the motion
      of the injured knee and increase the work done at the hip and ankle, perhaps in an effort to
      avoid knee instability. Non-copers limit the motion of the knee by activating several muscles
      around the knee simultaneously. So while this may be effective in stabilizing the knee in the
      short term, this strategy may cause altered and potentially harmful loading patterns within
      the knee joint.

      The abnormal movement and altered muscle firing patterns of anterior cruciate
      ligament-injured athletes are believed to be a mechanism for knee osteoarthritis. Though
      anterior cruciate ligament reconstruction restores knee stability, surgery does not fully
      address the faulty movement of these individuals. Pre-operative perturbation training is
      effective in improving function and normalizing knee motion in some non-copers. Perturbation
      training does not improve the ability of all non-copers to return to sport, suggesting other
      patient factors may be related to post-surgical outcomes. Women are known to be at greater
      risk for anterior cruciate ligament injury than men, but recently poorer outcomes in women
      following surgery have also been found. In response to pre-operative training, women
      demonstrate improved function and gait symmetry, but recover much more slowly after surgery
      and demonstrate abnormal patterns and knee joint loads. Persistent faulty patterns in women
      warrants further study and our research can help us find ways for us to address these
      abnormalities.

      This goal of this work is to determine whether perturbation training can improve knee
      function and reduce faulty adaptations after anterior cruciate ligament reconstruction.
      Specifically, the aims of this project are to investigate whether the addition of
      post-operative perturbation training results in lower loading, better movement patterns and
      better functional outcomes than standard care.
    

Intervention name(s): Perturbation; Control
Intervention type(s): Other; Other
Intervention description(s): All subjects complete study protocol. Subjects randomized to the perturbation group will complete the additional perturbation exercises; Subjects will complete the study protocol (including nordic hamstrings, standing squats, drop jumps, triple single leg hopping, and tuck jumps)
Other intervention name(s): Intervention; Intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment