Cartilage Contact and Early Degeneration following ACL Reconstruction

ACL 重建后的软骨接触和早期退化

• 批准号: 8494574
• 负责人: Richard Kijowski
• 金额: $ 15.74万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8494574
• 关键词: Age; Anterior Cruciate Ligament; Area; Bilateral; Biological Markers; Biomechanics; Cadaver; Cartilage; Contralateral; Data; Degenerative polyarthritis; Development; Devices; Etiology; Fluoroscopy; Image; Imaging Techniques; Imaging technology; Individual; Injury; Investigation; Joints; Knee; Knee joint; Ligaments; Link; Location; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measures; Mechanics; Methods; Modeling; Morphology; Motion; Movement; Operative Surgical Procedures; Outcome; Pain; Pathogenesis; Patients; Pattern; Physiological; Physiology; Positioning Attribute; Proteoglycan; Reconstructive Surgical Procedures; Relaxation; Replacement Arthroplasty; Resolution; Risk Factors; Rotation; Sampling; Stress; Stretching; Structure; Technology; Testing; Thick; Time; Tissues; Translations; Work; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; base; bone; disability; early onset; follow-up; high risk; improved; in vivo; innovation; kinematics; ligament injury; novel; osteochondral tissue; pressure; prevent; public health relevance; quadriceps muscle; reconstruction; rho; shear stress; skeletal; soft tissue; tibia; volunteer

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) tears are an extremely common and debilitating injury. ACL reconstruction surgery is successful at improving short-term function. However, long-term outcomes remain sub-optimal with a large majority of patients developing osteoarthritis (OA) at 10-15 year follow-up, which can result in extended periods of pain and disability before joint replacement becomes a feasible option. Thus, there is an urgent need to develop improved treatment options for patients with ACL reconstruction to halt the progression of joint degeneration and thereby improve long-term outcomes. This study will investigate whether altered cartilage contact patterns persist following ACL reconstructive surgery, and then contribute to the pathogenesis of early cartilage degeneration. The first Aim will establish a new dynamic magnetic resonance (MR) imaging approach for rapidly acquiring three-dimensional (3D) image volumes during knee flexion-extension motion. High resolution models of bone and cartilage morphology will be optimally registered with these dynamic images, allowing for simultaneous analysis of joint motion and inter-segmental cartilage contact. The second Aim will assess whether abnormal cartilage contact patterns are evident during loaded movement in ACL reconstructed knees. Eighteen patients who underwent ACL reconstructive surgery between 1 and 2 years prior will be bilaterally imaged while performing a knee flexion-extension task within the bore of a 3.0T MR scanner. The data will be used to test the hypothesis that relatively small changes in knee motion can significantly shift the cartilage contact to regions that are less accustomed to compressive loading. The final Aim will investigate the relationship between cartilage contact and MR parameters of early cartilage degeneration. The 18 subjects with ACL reconstruction in Aim 2 will undergo high resolution morphological and physiological imaging to identify regional changes in cartilage composition and thickness. Cartilage T1-rho and T2 relaxation time and cartilage thickness maps will be compared to cartilage contact maps in the reconstructed and contralateral knees. These data will be used to test the hypothesis that areas of cartilage which are loaded in the reconstructed knee but not the contralateral knee will show the greatest changes in MR biomarkers of cartilage physiology and morphology. Successful completion of this exploratory proposal will establish the MR technology needed to further investigate the pathogenesis of OA in patients with ACL reconstruction while also considering the influence of other potential risk factors including meniscal tears and osteochondral injuries. The innovative approach could also be used to assess the efficacy of alternative surgical treatment options for patients with ACL injury which may better restore joint kinematics and thereby prevent the development of early OA.

描述（由申请人提供）：前十字韧带 (ACL) 撕裂是一种极其常见且使人衰弱的损伤。 ACL 重建手术成功地改善了短期功能。然而，长期结果仍然不理想，绝大多数患者在 10-15 年的随访中出现骨关节炎 (OA)，这可能会导致关节置换术成为可行选择之前长时间的疼痛和残疾。因此，迫切需要为 ACL 重建患者开发改进的治疗方案，以阻止关节退变的进展，从而改善长期结果。这项研究将调查 ACL 重建手术后软骨接触模式的改变是否持续存在，从而促进早期软骨退化的发病机制。第一个目标将建立一种新的动态磁共振（MR）成像方法，用于在膝关节屈伸运动期间快速采集三维（3D）图像体积。骨和软骨形态的高分辨率模型将与这些动态图像进行最佳配准，从而可以同时分析关节运动和节段间软骨接触。第二个目标将评估 ACL 重建膝盖在负载运动期间是否存在明显的异常软骨接触模式。 18 名在 1 至 2 年前接受过 ACL 重建手术的患者将在 3.0T MR 扫描仪的孔内执行膝关节屈伸任务时进行双侧成像。这些数据将用于检验这样的假设：膝盖运动相对较小的变化可以显着地将软骨接触转移到不太习惯压缩载荷的区域。最终目标将研究软骨接触与早期软骨退变的 MR 参数之间的关系。目标 2 中进行 ACL 重建的 18 名受试者将接受高分辨率形态学和生理成像，以识别软骨成分和厚度的区域变化。软骨 T1-rho 和 T2 松弛时间和软骨厚度图将与重建膝盖和对侧膝盖的软骨接触图进行比较。这些数据将用于检验以下假设：重建膝关节而非对侧膝关节中加载的软骨区域将显示软骨生理学和形态学的 MR 生物标志物的最大变化。这一探索性提案的成功完成将建立进一步研究 ACL 重建患者 OA 发病机制所需的 MR 技术，同时考虑其他潜在危险因素（包括半月板撕裂和骨软骨损伤）的影响。这种创新方法还可用于评估 ACL 损伤患者的替代手术治疗方案的疗效，这可能会更好地恢复关节运动学，从而预防早期 OA 的发展。

项目成果

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees.

负载对健康和 ACL 重建膝关节体内胫股和髌股运动学的影响。

• 发表时间: 2017-12
• 作者: Kaiser, Jarred M;Vignos, Michael F;Kijowski, Richard;Baer, Geoffrey;Thelen, Darryl G
• 通讯作者: Thelen, Darryl G

Load-dependent variations in knee kinematics measured with dynamic MRI.

通过动态 MRI 测量膝关节运动学的负载相关变化。

• 发表时间: 2013-08-09
• 影响因子: 2.4
• 作者: Westphal, Christopher J;Schmitz, Anne;Reeder, Scott B;Thelen, Darryl G
• 通讯作者: Thelen, Darryl G

Accuracy of model-based tracking of knee kinematics and cartilage contact measured by dynamic volumetric MRI.

通过动态体积 MRI 测量的基于模型的膝关节运动学和软骨接触跟踪的准确性。

• 发表时间: 2016
• 影响因子: 2.2
• 作者: Kaiser, Jarred;Monawer, Arezu;Chaudhary, Rajeev;Johnson, Kevin M;Wieben, Oliver;Kijowski, Richard;Thelen, Darryl G
• 通讯作者: Thelen, Darryl G

American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament.

2015 年美国生物力学学会临床生物力学奖：前十字韧带重建后软骨力学、形态和成分的 MRI 评估。

• 发表时间: 2016-05
• 作者: Kaiser J;Vignos MF;Liu F;Kijowski R;Thelen DG
• 通讯作者: Thelen DG