Vibration and Post-traumatic Osteoarthritis Risk Following ACL Injury

The Effects of Vibratory Stimuli on Joint Health and Post-traumatic Osteoarthritis Risk Following Anterior Cruciate Ligament Injury

Background: Post-traumatic knee osteoarthritis (PTOA) is a leading cause of medical separation from military service. Anterior cruciate ligament injury and surgical reconstruction (ACLR) incurs a high PTOA risk and is an ideal model for evaluating PTOA prevention strategies. Aberrant gait biomechanics are a primary contributor to PTOA development and are attributable in part to quadriceps muscle dysfunction. Vibration acutely improves quadriceps function and gait biomechanics in individuals with ACLR, but its effects on joint health and PTOA risk are unknown. Hypothesis/Objective: The objective of this study is to evaluate the effects of vibration embedded in ACLR rehabilitation on 1) quadriceps function, 2) gait biomechanics, 3) patient self-report outcomes, and 4) MRI indicators of knee joint health. The central hypothesis is that vibration will enhance gait biomechanics consistent with reduced PTOA risk and that whole body vibration (WBV) delivered by a commercial device and local muscle vibration (LMV) delivered by a prototype device will produce equivalent improvements in the study outcomes. The rationale for the hypothesis is that vibration will more effectively improve quadriceps function compared to standard rehabilitation, thus restoring normal gait biomechanics and mitigating declines in joint health. Specific Aim 1: To compare the effects of Standard rehabilitation vs. Vibration rehabilitation (WBV and LMV) on quadriceps function. The investigators hypothesize that Vibration will produce superior outcomes (e.g. strength) compared to Standard rehabilitation, but that WBV and LMV will produce similar outcomes. Specific Aim 2: To compare the effects of Standard rehabilitation vs. Vibration rehabilitation (WBV and LMV) on gait biomechanics linked to PTOA development. The investigators hypothesize that Vibration will produce superior outcomes compared to Standard rehabilitation, but that WBV and LMV will produce similar outcomes. Specific Aim 3: To compare the effects of Standard rehabilitation vs. Vibration rehabilitation (WBV and LMV) on patient self-report outcomes. The investigators hypothesize that Vibration will produce superior outcomes compared to Standard rehabilitation, but that the outcomes will be similar between the WBV and LMV cohorts. Specific Aim 4: To compare the effects of Standard rehabilitation vs. Vibration rehabilitation (WBV and LMV) on MRI indicators of knee joint health. The investigators hypothesize that cartilage composition (e.g. collagen, water, and proteoglycan content) will be poorer and PTOA incidence (MOAKS score) will be higher in the Standard cohort compared to both Vibration cohorts, but that WBV and LMV will produce similar outcomes. Study Design: The approach will be to recruit ACLR patients at the onset of rehabilitation and conduct a Phase II single-blind randomized controlled trial to compare the effects of standard ACLR rehabilitation (control) vs. standard rehabilitation that incorporates WBV or LMV on quadriceps function, gait biomechanics, patient self-report outcomes, cartilage composition, and PTOA incidence over the first year post-ACLR. Impact: The proposed work will evaluate the effects of a novel rehabilitation approach (vibration) for preventing PTOA. PTOA is a leading cause of medical separation from military service, degrades quality of life, increases the risks of several comorbidities (e.g. obesity, depression, cardiovascular disease), and is a primary contributor to years of life lost due to disability. Improving rehabilitation of knee injuries is paramount for maintaining the combat readiness of the armed forces and preserving the health and well-being of Service members and Veterans, as well as millions of Americans who are at risk of PTOA. Vibration represents a promising approach to this important challenge. Furthermore, in addition to being cost-effective, the portable nature of the prototype LMV device could have substantial implications for military personnel and US citizens, particularly those with limited access to rehabilitation facilities. The proposed work represents the critical translational link between existing pre-clinical data and the clinical setting that is necessary to establish its efficacy and accelerate its development as a commercially available device.

Vibration and Post-traumatic Osteoarthritis Risk Following ACL Injury

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