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

基本信息

批准号：
10347360
负责人：
Niccolo M Fiorentino
金额：
$ 25.93万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-08 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10347360
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 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 biomechanical test bone comparative cost early onset effective therapy experience high risk improved in vivo insight interest joint biomechanics knee mechanics longitudinal analysis member meniscus injury novel pain reduction patient population recruit repaired return to sport skills targeted treatment theories therapeutic target tibia

项目摘要

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.

项目概要据估计，每年有 120,000 例前十字韧带 (ACL) 撕裂需要通过手术修复美国。手术修复可以稳定 ACL 缺陷的膝盖，但越来越多的证据表明，手术不会改变早发性骨关节炎（称为创伤后骨关节炎）的进展 (PTOA) 接受前交叉韧带重建 (ACLR) 的患者更有可能发生 PTOA，尤其是那些在半月板撕裂和半月板切除术同时遭受半月板损伤的人。大约 21%-48% 的患者的长期膝关节健康会遭受灾难性后果。在 ACLR 期间切除全部或部分半月板的患者继续发展为 PTOA。尚未设想出半月板切除术后停止 PTOA 的治疗方法，因为尽管整体恢复，但疾病发展的理论机制尚不清楚。稳定性、ACL 手术重建和半月板切除改变了膝关节的生物力学关节：改变软骨对负载的反应方式，改变胫骨和股骨之间的接触点软骨，增加胫骨和股骨在物理过程中相互移动的速度活动，并减少骨头之间的距离，进而减少软骨的部分。该理论的核心是骨骼的概念。与非手术膝盖相比，虽然这种说法在概念上是有道理的，但它是不同的。身体活动期间骨骼的关节可能没有不同，而是关节软骨受伤时的损伤会开始一系列分解代谢事件，最终导致关节间隙宽度的损失—— 研究小组成员拥有必要的技能、专业知识和骨关节炎的标志性成果。通过直接测量来支持或反驳上述假设框架的设备具体来说，高速双透视（一种 X 射线技术）将测量骨骼。具有亚毫米和亚度偏差和精度的运动；定量磁共振成像 (qMRI) 将评估软骨成分；传统 MRI 将量化三维软骨结构。目前的建议是，PTOA 疾病发作和进展的生物力学标志物将在一次测量这项纵向研究将实现以下两个目标：改善。通过对体内膝关节进行左右比较分析来了解 PTOA 发病机制 ACLR+M 一年后患者的力学（胫股软骨应变和关节运动学）目标 2：通过对纵向变化进行基于图像的分析，提高对 PTOA 发病机制的理解完成本提案中的目标将产生新的、有影响力的见解。 PTOA 通过提高我们对初始事件的理解，加快了 ACLR+M 患者的治疗时间与 PTOA 的发生和早期进展相关。