Biomechanical Markers of PTOA after ACL Reconstruction and Meniscal Resection

ACL 重建和半月板切除后 PTOA 的生物力学标志物

• 批准号: 10156542
• 负责人: Niccolo M Fiorentino
• 金额: $ 26.19万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-08 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10156542
• 关键词: 3-Dimensional; Address; Ancillary Study; Anterior Cruciate Ligament; Area; Base Composition; Biomechanics; Body Weight; Cartilage; Cartilage Matrix; Catabolism; Collagen; Contralateral; Data; Degenerative polyarthritis; Development; Disease; Disease Progression; Equipment; Event; Excision; Exercise; Exhibits; Femur; Fluoroscopy; Future; Goals; Health; Healthcare Systems; Hyaline Cartilage; Image; Implant; Incidence; Individual; Injury; Intervention; Joints; Knee; Knee joint; Ligaments; Literature; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measurement; Measures; Mechanical Stress; Mechanics; Meniscus structure of joint; Motion; Movement; Onset of illness; Operative Surgical Procedures; Outcome; Parents; Pathogenesis; Patient Recruitments; Patients; Physical Rehabilitation; Physical activity; Proteoglycan; Reconstructive Surgical Procedures; Resolution; Risk; Roentgen Rays; Side; Slide; Speed; Stress; Structure; Techniques; Testing; Therapeutic; Therapeutic Intervention; Thick; Thinness; Time; TimeLine; Tissues; United States; Volition; Width; Work; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; articular cartilage; base; bone; comparative; cost; early onset; effective therapy; experience; high risk; improved; in vivo; insight; interest; knee mechanics; longitudinal analysis; member; meniscus injury; novel; pain reduction; patient population; recruit; repaired; return to sport; skills; targeted treatment; theories; therapeutic target; tibia

Project Summary An estimated 120,000 anterior cruciate ligament (ACL) tears are repaired surgically on an annual basis in the United States. Surgical repair stabilizes the ACL-deficient knee, but a growing body of evidence suggests that surgery does not alter the progression to early-onset osteoarthritis, known as post-traumatic osteoarthritis (PTOA). Patients who undergo anterior cruciate ligament reconstruction (ACLR) are more likely to get PTOA, especially those who sustained a meniscal injury at the same time as their ACL tear. Meniscal resection and removal can have disastrous consequences for patients’ long-term knee joint health. Approximately 21%-48% of patients who had all or part of their meniscus removed during ACLR go on to develop PTOA. Effective treatments for stopping PTOA after meniscal resection have not been conceived because the reasons why the disease develops are not well understood. The theorized mechanism speculates that, despite restoring overall stability, surgical reconstruction of the ACL and resection of the meniscus alter the biomechanics of the knee joint: changing the way cartilage responds to load, shifting the point of contact between tibial and femoral cartilage, increasing the speed at which the tibia and femur bones move past one another during physical activities, and decreasing in the distance between the bones. In turn, sections of cartilage experience unaccustomed loads, and irreversible damage results. Central to this theory is the notion that the bones articulate differently compared to non-surgical knees. While this argument makes sense conceptually, it’s possible that the bones do not articulate differently during physical activity, but instead articular cartilage damage at the time of injury starts a sequence of catabolic events culminating in loss of joint space width—the hallmark outcome of osteoarthritis. The study team members possess the necessary skills, expertise and equipment to support or refute the aforementioned hypothetical framework through direct measurements of biomechanical factors. Specifically, high-speed dual fluoroscopy, an X-ray technique, will measure bone motion with submillimeter and subdegree bias and precision; quantitative magnetic resonance imaging (qMRI) will assess cartilage composition; traditional MRI will quantify three-dimensional cartilage structure. In the current proposal, biomechanical markers for PTOA disease onset and progression will be measured at one and two years after surgery. This longitudinal study will address the following two aims. Aim 1: To improve understanding of PTOA pathogenesis by performing a side-to-side comparative analysis of in-vivo knee mechanics (tibiofemoral cartilage strain and arthrokinematics) in patients one year after ACLR+M. Aim 2: To improve understanding of PTOA pathogenesis by performing an image-based analysis of longitudinal changes in cartilage after ACLR+M. Completion of the aims in this proposal will generate new and impactful insights into PTOA’s accelerated timeline in ACLR+M patients by improving our understanding of the initial events associated with the onset and early progression to PTOA.

项目摘要 估计有120,000个前交叉韧带（ACL）的眼泪每年通过外科手术修复 美国。手术修复稳定了ACL缺乏膝关节，但越来越多的证据表明， 手术不会改变早期发作的骨关节炎的进展，称为创伤后骨关节炎 （PTOA）。接受前交叉韧带重建（ACLR）的患者更有可能获得PTOA， 特别是那些与ACL撕裂同时遭受半月板伤害的人。半月板切除和 去除可能会对患者的长期膝关节健康造成灾难后果。大约21％-48％ 在ACLR期间，将全部或部分弯月面的患者继续发展为PTOA。有效的 半月板切除后停止PTOA的治疗方法尚未想到，因为 疾病发展尚不清楚。理论机制推测，目的地恢复了整体 稳定性，ACL的手术重建和半月板切除改变了膝盖的生物力学 关节：改变软骨对负载的反应方式，转移胫骨和股骨之间的接触点 软骨，增加胫骨和股骨骨头在物理过程中彼此移动的速度 活动，并减少骨骼之间的距离。反过来，软骨体验的各个部分 不习惯的负载和不可逆的损坏结果。这个理论的核心是骨头的观念 与非手术的膝盖相比，表达方式不同。尽管这个论点在概念上是有意义的，但这是 在体育锻炼期间，骨骼的表达方式可能不会有所不同，而是关节软骨 受伤时的损害开始了一系列分解代谢事件，最终导致关节空间宽度的丧失 - 骨关节炎的标志结果。学习团队成员具有必要的技能，专业知识和 通过直接测量的设备来支持或反驳近似假设的框架 生物力学因素。具体而言，高速双重荧光镜，一种X射线技术，将测量骨头 带有亚毫米和次级偏见和精确度的运动；定量磁共振成像（QMRI） 将评估软骨组成；传统MRI将量化三维软骨结构。在 当前的建议，PTOA疾病发作和进展的生物力学标志物将以一个 手术后两年。这项纵向研究将解决以下两个目标。目标1：改善 通过对体内膝关节进行左右比较分析来了解PTOA发病机理 ACLR+M后一年患者的力学（胫股骨软骨菌株和关节化学）。目标2：到 通过对纵向变化进行基于图像的分析来提高对PTOA发病机理的了解 在ACLR+M之后的软骨中。该提案中目标的完成将产生新的和有影响力的见解 通过改善我们对初始事件的理解，PTOA在ACLR+M患者中的加速时间表 与发作和早期发展为PTOA有关。