# A simple and quantitative clinical assessment of neuromuscular recovery after ACL injury

> **NIH NIH R44** · NEUROMUSCULAR DYNAMICS, LLC · 2022 · $417,624

## Abstract

PROJECT ABSTRACT
Anterior cruciate ligament (ACL) tears are one of the most common knee injuries and often
occur during dynamic foot-ground interactions. ACL reconstructive surgery paired with physical
therapy is the standard of care. However, there is a high risk of re-injury even after rehabilitation
and clearance to return to full unrestricted activity (RTA). This is because methods of
rehabilitation and criteria to evaluate RTA are not standardized to evaluate deficiency in
neuromuscular control of the leg (i.e., leg dexterity). Current tests for leg dexterity are not
quantitative and are often risky as they require performing dynamic weight-bearing maneuvers.
Also, neuromuscular control differs between sexes, and women have a 6-10 times greater risk
of ACL injury. There is no test that can quantify leg dexterity simply and safely in the outpatient
setting to determine RTA readiness in women and men. Neuromuscular Dynamics, LLC (NMD)
developed the leg version of the Valero Dexterity Test™. It effectively quantifies the
neuromuscular system control of dynamic foot-ground interactions without exposing the patient
to large forces or full-weight bearing maneuvers. It can detect deficits in neuromuscular control,
sex differences in it, and inform rehabilitation strategies and RTA readiness. In Phase I we
developed a portable, battery-operated Leg Dexterity Test device, improved tablet UI/UX, and
deployed a cloud-computing platform. We also manufactured medical grade compression
springs, identified reimbursement codes and the regulatory path for this Class I, FDA 510(k)
exempt device. We also demonstrated proof-of-concept that the Leg Dexterity Test can
measure leg dexterity and confirmed the hypothesis that patients have disrupted dexterity after
being cleared for RTA. The system was enthusiastically adopted by clinicians and rated as
excellent in Usability Score. Moreover, we demonstrated ability to implement a single IRB
protocol across 4 clinical centers. Phase II will optimize manufacturing and cloud computing at
scale and demonstrate clinical efficacy of Leg Dexterity Test to inform rehabilitation and improve
RTA decision making. Aim 1: Manufacturing and firmware will be optimized. In Aim 2: Tablet
software will be improved. Aim 3: Software-as-a-service and cloud computing will be
implemented to automate analytics and data display for report generation. Aim 4: A 3-year
longitudinal study will follow patients from ACL injury through clearance, and test control
subjects to establish healthy levels of leg dexterity to inform clearance and to determine rates of
recovery. These Aims will develop a commercialization-ready Leg Dexterity Test and
demonstrate its efficacy in optimizing rehabilitation and informing RTA decisions.

## Key facts

- **NIH application ID:** 10463736
- **Project number:** 5R44AR074859-04
- **Recipient organization:** NEUROMUSCULAR DYNAMICS, LLC
- **Principal Investigator:** Thomas S Buchanan
- **Activity code:** R44 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $417,624
- **Award type:** 5
- **Project period:** 2019-09-12 → 2025-08-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10463736

## Citation

> US National Institutes of Health, RePORTER application 10463736, A simple and quantitative clinical assessment of neuromuscular recovery after ACL injury (5R44AR074859-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10463736. Licensed CC0.

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