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Can Neuromuscular Training Alter Movement Patterns

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by University of Delaware
Sponsor:
Information provided by (Responsible Party):
Lynn Snyder-Mackler, University of Delaware
ClinicalTrials.gov Identifier:
NCT01773317
First received: June 13, 2012
Last updated: April 2, 2014
Last verified: April 2014

June 13, 2012
April 2, 2014
August 2011
August 2015   (final data collection date for primary outcome measure)
Changes in gait patterns from baseline to completion of intervention (approximately 6 months after surgery), 1 year after anterior cruciate ligament reconstruction and 2 years after anterior cruciate ligament reconstruction [ Time Frame: At enrollment (baseline), After protocol intervention (approximately 6 months after surgery), 1 year after anterior cruciate ligament reconstruction, 2 year after anterior cruciate ligament reconstruction ] [ Designated as safety issue: No ]
Motion analysis data of gait patterns will be collected to analyze gait movement patterns of individuals after anterior cruciate ligament reconstruction and over time.
Same as current
Complete list of historical versions of study NCT01773317 on ClinicalTrials.gov Archive Site
  • Quadriceps Strength [ Time Frame: At enrollment (baseline), After protocol intervention (approximately 6 months after surgery),1 year after anterior cruciate ligament reconstruction, 2 years after anterior cruciate ligament reconstruction ] [ Designated as safety issue: No ]
  • Patient reported outcomes (Knee Outcomes Survey-Activity of Daily Living Scale, Global Rating Score of Perceived Knee Function) [ Time Frame: At enrollment (baseline), After protocol intervention (approximately 6 months after surgery), 1 year after anterior cruciate ligament reconstruction, 2 years after anterior cruciate ligament reconstruction ] [ Designated as safety issue: No ]
  • Single-legged hop measures [ Time Frame: At enrollment (baseline), After protocol intervention (approximately 6 months after surgery), 1 year after anterior cruciate ligament reconstruction, 2 years after anterior cruciate ligament reconstruction ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Can Neuromuscular Training Alter Movement Patterns
Can Neuromuscular Training Alter Movement Patterns After Anterior Cruciate Ligament Injury?

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 14-40 at the time of injury are eligible. All eligible subjects must undergo anterior cruciate ligament reconstruction by a single surgeon using quadrupled hamstring autograft or soft tissue allograft and the designated preoperative and postoperative rehabilitation at University of Delaware Physical Therapy clinic. Using a prospective randomized design, 40 subjects who received University of Delaware Physical Therapy post-operative treatment protocol 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 8 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.

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.

Interventional
Phase 0
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
Acute Injury of Anterior Cruciate Ligament
Other: Perturbation
all subjects complete study protocol. Subjects randomized to the perturbation group will complete the additional perturbation exercises
Other Name: Intervention
  • Experimental: Perturbation
    neuromuscular training and strength training
    Intervention: Other: Perturbation
  • Experimental: Control
    Subjects will complete the training protocol without the neuromuscular component
    Intervention: Other: Perturbation
White K, Di Stasi SL, Smith AH, Snyder-Mackler L. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial. BMC Musculoskelet Disord. 2013 Mar 23;14:108. doi: 10.1186/1471-2474-14-108.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
80
August 2016
August 2015   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • regular participants in activities that involve cutting, pivoting, jumping, and lateral movements prior to injury
  • ages 13-55 at the time of injury
  • undergo Anterior Cruciate Ligament reconstruction using quadrupled hamstring autograft or soft tissue allograft

Exclusion Criteria:

  • concomitant Grade III ligament tears
  • osteochondral defects >1cm2
  • history of previous Anterior Cruciate Ligament Reconstruction or other major lower extremity injury/surgery
Both
14 Years to 40 Years
No
Contact: Lynn Snyder-Mackler, PT, ATC, ScD 302-831-3613 smack@udel.edu
Contact: Thomas Buchanan, BS, MS, PhD 302-831-2401 buchanan@udel.edu
United States
 
NCT01773317
225014-1
No
Lynn Snyder-Mackler, University of Delaware
Lynn Snyder-Mackler
Not Provided
Principal Investigator: Lynn Snyder-Mackler, PT,ATC,ScD University of Delaware
University of Delaware
April 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP