Multi-faceted Approach to Modeling ACL Injury Mechanisms

ACL 损伤机制建模的多方面方法

• 批准号: 8911250
• 负责人: Timothy E Hewett
• 金额: $ 62.78万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8911250
• 关键词: Accounting; Algorithms; Anatomy; Anterior; Anterior Cruciate Ligament; Biomechanics; Cadaver; Clinical; Computer Simulation; Computers; Data; Elements; Eligibility Determination; Enrollment; Evidence Based Medicine; Failure; Funding; General Population; Grant; Health; Health Care Costs; In Vitro; Incidence; Individual; Injury; Intervention; Kinetics; Knee; Knee Injuries; Knowledge; Laboratories; Lead; Life; Ligaments; Link; Literature; Measures; Mechanics; Medial; Medical; Meta-Analysis; Methodology; Methods; Modeling; Motion; Movement; National Institute of Child Health and Human Development; Pattern; Physiological; Populations at Risk; Prevention program; Preventive; Primary Health Care; Protocols documentation; Public Health; Randomized Controlled Trials; Relative (related person); Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Role; Rotation; Rupture; Sensitivity and Specificity; Series; Specimen; Structure of medial collateral ligament of knee joint; Techniques; Testing; Tissues; Training; Translating; United States; United States National Institutes of Health; Validation; Work; anterior cruciate ligament rupture; base; biomechanical model; clinical application; clinical predictors; clinically relevant; collateral ligament; cost effective; evidence base; high risk; human subject; improved; in vitro testing; in vivo; injury prevention; kinematics; ligament injury; modifiable risk; neuromuscular; novel; parent grant; research study; response; screening; sex; tool

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) injury is a major medical and financial burden. Despite identification of modifiable risk factors and effective preventive measures, global ACL injury incidence remains largely unaffected. Under the parent grant we identified plausible valgus collapse mechanisms for ACL injury without concomitant medial collateral ligament (MCL) injury. A novel cadaveric testing setup we developed under the funded grant has demonstrated a nearly 90% rate of ACL tear. Our findings show that combined knee abduction moment (KAM), anterior tibial shear force (ATS) and internal tibial rotation moment (ITR) generates significantly greater strain in the ACL relative to the MCL, and reproduces kinematics similar to those observed during ACL injury. While these types of loading, in isolation, increase ACL strain and potentially risk of injury, their combined effects o ACL biomechanics are not well understood. In this competing renewal application we will develop a highly impactful and unique ACL injury risk assessment protocol that accounts for multiplanar biomechanics. The protocol will be developed through a novel, integrative in vivo, in vitro and in silico (in sim) approach. The Specific Aims are: I) To develop and validate a multiplanar ACL injury risk assessment algorithm that predicts ACL injury risk based on dynamic ACL strain, and II) To integrate in vivo, in vitro and in silico approaches to establish a 'continuum of risk' that accounts for the relative contributions of KAM, ITR, and ATS to ACL rupture. The critical distinction between the two Aims is the biomechanical context: Aim I will determine how the ACL is strained during non-injurious screening tasks that can be performed in a laboratory or clinical setting. Aim II will establish a direct link between high strain movemet patterns and the ACL injury mechanism(s). We hypothesize that: I) Peak input values of KAM, ITR, and ATS from in vivo data will accurately predict peak ACL strain when landing biomechanics are reproduced in vitro and in silico, and II) Incremental increases in KAM, ITR and ATS, scaled from 'high-risk' in vivo measures will lead to ACL rupture in vitro and in silico. In Specific Aim I, multi-planar kinematics and kinetics will be directly used as inputs to our validated, sex-specific, viscoelastic FE knee models and in vitro test protocols to test our hypotheses. We will also aim to identify and validate simple, clinically-based predictors for KAM, ITR, and ATS to maximize the clinical applicability of the protocol. In Aim II, we will directly examine the roles of KAM, ITR and anterior tibial shear on the likelihood of ACL rupture. High-risk in vivo values for KAM, ATS, and ITR will be incrementally increased until tissue failure is achieved in cadavers, or ACL failure strains are reached in FE models. Furthermore, in Aim II we will optimize our FE modeling approach through validation of a methodology to customize models that accounts for variability in anatomy and tissue mechanics. This research will significantly improve the ability of researchers and clinicians to effectively screen athletes for ACL injury risk, and will increase ACL injury prevention program enrollment and efficacy.

描述（由申请人提供）：前交叉韧带（ACL）受伤是主要的医疗和经济负担。尽管确定了可修改的危险因素和有效的预防措施，但全球ACL损伤的发生率仍然在很大程度上不受影响。在父母赠款的情况下，我们确定了无伴随的内侧副韧带（MCL）损伤的ACL损伤的合理外翻机制。我们在资助的赠款中开发的一种新型的尸体测试设置显示了近90％的ACL撕裂。我们的发现表明，膝关节外展矩（KAM），胫骨前剪切力（ATS）和内胫骨内部旋转矩（ITR）相对于MCL产生明显更大的应变，并再现类似于ACL损伤期间观察到的运动学。尽管这些类型的负载分别增加了ACL菌株和潜在的损伤风险，但它们的综合作用O ACL生物力学尚不清楚。在此相互竞争的续签应用中，我们将开发一种具有多个生物力学的高度影响力和独特的ACL伤害风险评估方案。该方案将通过一种新颖的，体内的整合性，体外和计算机（以SIM）方法开发。具体目的是：i）开发和验证一种基于动态ACL菌株的ACL损伤风险的多平面ACL损伤风险评估算法，ii）ii）在体内和硅的方法中整合了建立风险连续性的方法，以建立一种占KAM，ITR的相对贡献，ITR和Acl aCl pultul pults cants ands。这两个目标之间的临界区别在于生物力学背景：目的我将确定在可以在实验室或临床环境中执行的非妇女筛查任务中ACL的紧张。 AIM II将建立高应变移动模式与ACL损伤机制之间的直接联系。 We hypothesize that: I) Peak input values of KAM, ITR, and ATS from in vivo data will accurately predict peak ACL strain when landing biomechanics are reproduced in vitro and in silico, and II) Incremental increases in KAM, ITR and ATS, scaled from 'high-risk' in vivo measures will lead to ACL rupture in vitro and in silico.在特定的目标I中，多平面运动学和动力学将直接用作我们经过验证的，特定的性别粘弹性膝关节模型和体外测试方案的输入，以测试我们的假设。我们还将旨在识别和验证基于临床的简单，基于临床的KAM，ITR和ATS的预测因素，以最大程度地提高协议的临床适用性。在AIM II中，我们将直接研究KAM，ITR和胫骨前剪切在ACL破裂可能性上的作用。 KAM，ATS和ITR的高风险体内值将逐渐增加，直到在尸体中实现组织衰竭，或者在FE模型中达到ACL衰竭菌株。此外，在AIM II中，我们将通过验证方法来定制解剖学和组织力学可变性的方法来优化我们的FE建模方法。这项研究将显着提高研究人员和临床医生有效筛查ACL损伤风险的能力，并增加ACL伤害预防计划的入学率和功效。