# Clinically Assessed Risk Factors for a Second ACL Injury Using an Innovative Wearable Sensor

> **NIH NIH R01** · VIRGINIA POLYTECHNIC INST AND ST UNIV · 2024 · $622,479

## Abstract

Clinically Assessed Risk Factors for a Second ACL Injury Using an Innovative Wearable Sensor
Project Summary
Nearly 1 in 60 adolescent athletes will suffer ACL injuries. Approximately 90% of these injured athletes will
undergo an ACL reconstruction at an estimated annual cost of $3 billion. While reconstruction and subsequent
rehabilitation allow these athletes to return to sports, they have a 15-fold increased risk of sustaining a second
ACL injury, a tear of the ACL graft or the contralateral ACL, upon returning to sports. Many patients cleared to
return to sport by their physicians demonstrate residual muscle weakness, as well as asymmetrical movement
and loading patterns. Therefore, we contend that the underlying problem with current clinical return to sport
decision making is the lack of evidence-based load asymmetry evaluation methods that can be collected in a
clinical setting. Evidence about the clinical relevance of asymmetry has been collected in research-based
motion capture labs. It is not feasible to include costly and time intensive motion capture data collection in
clinical settings. Despite laboratory-based evidence that asymmetries (landing and muscle strength) increase
the risk of a second ACL injury, these measures are not able to be measured in clinical settings to determine
return to sport readiness. Our study has the potential to significantly impact post-ACL clinical care by identifying
the combination of traditional clinical and novel clinic-based return to sport measures that identify patients at
high risk for a second ACL injury and achieve our long-term goal of decreasing the number of ACL re-tears
through targeted interventions. Specifically, we propose to evaluate load asymmetry in the clinical setting using
a new load-sensing insole to determine the predictive associations of an innovative set of clinic-based functional
load symmetry measures. We will then develop a prognostic model from a comprehensive set of traditional
clinical measures (clinical characteristics and neuromuscular performance) and the proposed novel clinical
assessments (psychological/ behavioral readiness and functional load symmetry) to predict second ACL injury.
We will recruit 240 ACL reconstructed patients for model development and 120 ACL reconstructed patients for
external validation (14-25 years old) who have been released to return to sports. Clinician assessments, patient
self-reported data, and load asymmetry measures will be collected in a clinic-like setting. All patients will
complete injury surveillance for 18 months following return to sport (24 months following ACL reconstruction).
The goals of this observational study are to: 1) Determine whether functional load symmetry measures
significantly improve predictive accuracy for a second ACL injury over current standard of care clinical measures
used in return to sport decisions; and 2) Develop a prognostic model from a comprehensive set of traditional
clinical measures (clinical char...

## Key facts

- **NIH application ID:** 10634554
- **Project number:** 5R01AR078811-03
- **Recipient organization:** VIRGINIA POLYTECHNIC INST AND ST UNIV
- **Principal Investigator:** Robin M Queen
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $622,479
- **Award type:** 5
- **Project period:** 2021-07-28 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10634554

## Citation

> US National Institutes of Health, RePORTER application 10634554, Clinically Assessed Risk Factors for a Second ACL Injury Using an Innovative Wearable Sensor (5R01AR078811-03). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10634554. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*