Functional Resistance Training to Improve Knee Function After ACL Reconstruction

Study Overview
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Brief Summary
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The purpose of this study is to examine if thigh muscle weakness and the lack of muscle activation that accompanies ACL injury and reconstruction can be improved with functional resistance training.

Detailed Description
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Profound quadriceps weakness is ubiquitous after anterior cruciate ligament (ACL) reconstruction, and current rehabilitation approaches are not successful in optimizing quadriceps strength and knee function even years after the surgery. We hypothesize that suboptimal strength and functional outcomes after ACL surgery are due to the lack of task-specific exercise elements during strength training. This application seeks to assess whether progressive functional resistance training during gait will significantly improve quadriceps function, neural excitability, and knee mechanics during gait. The proposed studies will not only lay the foundation for a novel training paradigm, but will also improve our understanding of the mechanisms mediating neuromuscular and biomechanical changes after functional resistance training.

Official Title
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Functional Resistance Training During Gait: A Novel Intervention to Improve Knee Knee Function After ACL Reconstruction

Conditions
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Anterior Cruciate Ligament Injury

Intervention / Treatment
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* Other: Functional Resistance Training with Brace
* Other: Control
* Other: Functional Resistance Training with Elastic Band


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: aged 14-40 years suffered an acute, complete ACL rupture willingness to participate in testing and follow-up as outlined in the protocol English-speaking Exclusion Criteria: inability to provide written informed consent female subjects who are pregnant or are planning to become pregnant previous ACL injury previous surgery to either knee bony fracture accompanying ACL injury patients who experienced a knee dislocation; patients who are contraindicated for transcranial magnetic stimulation (e.g., metal implants in head, unexplained recurrent headaches, history of seizures, epileptogenic drugs, active psychiatric illness, etc.).

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Functional Resistance Training with a Brace<br>Participants will receive functional resistance training via a knee brace while walking on a treadmill 2-3 times a week for about 8 weeks. | Other: Functional Resistance Training with Brace<br>* A brace will be strapped to the leg and apply resistance across the knee while subjects walk on a treadmill.<br>|
| Experimental: Functional Resistance Training with Elastic Band<br>Participants will receive functional resistance training via an elastic band attached at the ankle while walking on a treadmill 2-3 times a week for about 8 weeks. | Other: Functional Resistance Training with Elastic Band<br>* An elastic band will be strapped to the leg and apply resistance across the knee while subjects walk on a treadmill.<br>|
| Sham Comparator: Control<br>Participants will while on a treadmill without an applied resistance 2-3 times a week for about 8 weeks. | Other: Control<br>* A brace will be strapped to the leg and will not apply resistance across the knee while subjects walk on a treadmill.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quadriceps Muscle Strength | Isometric quadriceps strength was measured with the knee at 60 degrees using an isokinetic dynamometer prior to the intervention and immediately after the intervention. Post-test minus pre-test change scores were calculated. | Pre-test measurements were taken at  9-10 weeks after ACL reconstruction and Post-test measurements were taken at  18-20 weeks after ACL reconstruction. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quadriceps Voluntary Activation | Quadriceps voluntary activation was measured using the burst superimposition technique and calculated using the central activation ratio (CAR). The CAR formula is calculated using the peak torque generated immediately prior to the delivery of the stimulus (or the maximum voluntary isometric contraction, MVIC) being divided by the peak torque generated as a result of the electrical stimulus (MVIC plus superimposed burst) and then multiplied by 100. Equation is: MVIC/(MVIC + superimposed burst) × 100. A CAR of 100 represents complete volitional quadriceps activation. Voluntary activation was quantified immediately after the intervenapproximately 9-10 weeks after the int from baseline to the end of intervention will be assessed and compared between groups. | Immediately after the intervention or approximately 18-20 weeks after ACL reconstruction | 
| Knee Flexion Angle Symmetry | The knee flexion angle (measured in degrees) during the stance phase was gathered for both limbs using three dimension motion capture and recorded while subjects walked overground. A knee flexion angle symmetry score was computed using the following formula: ensemble average of knee flexion angle of ACL limb minus the ensemble average of knee flexion angle of the non-ACL limb. The mean difference between pre-intervention and post-intervention (post minus pre) knee flexion symmetry scores were calculated for each group. Higher values suggest greater increases in knee flexion angle symmetry from pre-intervention to post-intervention. | Pre-intervention values were recorded at  9-10 weeks after ACL reconstruction and before the start of the intervention. Post-intervention values were recorded after the 8-week intervention ( 18-20 weeks after ACL reconstruction) | 
| Knee Moment Symmetry | The sagittal plane knee moment (units Nm) during the stance phase was gathered for both limbs using three dimensional motion capture and recorded while subjects walk overground. A symmetry score was computed using the following formula: ensemble average of the knee moment of the ACL limb (Nm) - ensemble average of the knee moment of the non-ACL limb (Nm). The mean difference between pre-intervention and post-intervention knee moment symmetry scores (post minus pre) were calculated for each group. Higher values represent the greater increases in knee moment symmetry from pre-intervention to post-intervention. | Pre-intervention scores were recorded prior to the start of the intervention and approximately 9-10 weeks after ACL reconstruction. Post-intervention scores were recorded after the 8 week intervention or approximately 18-20 weeks after ACL reconstruction | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ACL, Quadriceps, Muscle, Resistance Training