Walk this Way: Physical Activity and Walking Biomechanics Lead to Early Knee OA Symptoms and Ultrasound-Detected Structural Pathology after ACL Reconstruction

以此方式行走：体力活动和行走生物力学导致 ACL 重建后早期膝关节 OA 症状和超声检测的结构病理学

• 批准号: 10670394
• 负责人: Matthew Harkey
• 金额: $ 12.72万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670394
• 关键词: Accelerometer; Atlases; Biomechanics; Bone Spur; Cartilage; Classification; Clinical; Clinical Trials; Clinical Trials Design; Collaborations; Data Analyses; Degenerative polyarthritis; Development; Devices; Diagnosis; Event; Evidence based intervention; Future; Grant; Injury; Joints; Knee; Knee Injuries; Knee Osteoarthritis; Laboratories; Lead; Level of Evidence; Life; Life Experience; Meniscus structure of joint; Mentors; Monitor; Motion; Operative Surgical Procedures; Outcome; Pain; Participant; Pathology; Patients; Persons; Physical activity; Popliteal Cyst; Population; Predisposition; Quality of life; Reaction; Reconstructive Surgical Procedures; Reporting; Research; Risk; Risk Factors; Sports Medicine; Standardization; Symptoms; Synovitis; System; Time; Training; Ultrasonography; United States; Visit; Walking; Work; adduct; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; biomechanical test; chronic pain; clinical trial participant; disability; effusion; evidence base; gait rehabilitation; high risk; improved; insight; joint loading; modifiable risk; novel; persistent symptom; prevent; radiological imaging; recruit; risk mitigation; skills; trial planning; ultrasound; young adult

PROJECT SUMMARY About 250,000 anterior cruciate ligament (ACL) injuries occur annually in the United States and are primarily treated with a surgical reconstruction (ACLR). However, for at least 1 in 3 young adults with an ACLR, the injury and surgery are pivotal life events that lead to chronic pain, diminished long-term quality of life, and an increased risk for osteoarthritis (OA). The 1st year post-ACLR is critical to a patient’s long-term outcomes as there is evidence that levels of pain and quality of life experienced at 1 year post-ACLR will remain unchanged for up to 10 years. Additionally, at 1 year post-ACLR, ~33% of young adults present with knee structural pathologies. Unfortunately, there are no evidence-based strategies to identify people during the 1st year post-ACLR who are at risk for chronic symptoms or structural pathology. Hence, we cannot identify susceptible populations and lack critical insights into which modifiable risk factors could decrease their risk and prevent lifelong disability. Potentially modifiable risk factors that are common throughout the 1st year post-ACLR are alterations in walking biomechanics and insufficient levels of physical activity. Since poor symptoms and pre-radiographic structural pathology are risk factors for the development of knee OA, understanding modifiable risk factors that relate to poor symptomatic and structural outcomes during the 1st year post-ACLR is needed for future studies to identify therapies that prevent OA. The objective of this study is to determine how longitudinal changes in PA and walking biomechanics assessed at 3, 6, 9, and 12 months post-ACLR relate to poor symptomatic or structural outcomes during the 1st year post-ACLR. This will be the first study that applies the following outcomes to young adults at multiple visits during the 1st year post-ACLR: 1) classification criteria for early OA symptoms, 2) clinically accessible whole-knee ultrasound scoring system to detect multiple structural pathologies. PA will be assessed with research-grade accelerometers to quantify steps per day and weekly minutes of moderate to vigorous PA during a 7-day period following each study visit. Walking biomechanics will be assessed in a motion capture laboratory to quantify vertical ground reaction force and internal knee adduction moment. My central hypothesis is that participants with a moderate change in PA and walking biomechanics post-ACLR will be less likely to have poor symptomatic and structural outcomes during the 1st year when compared to people with a rapid increase or no change in PA and walking biomechanics. The expected outcome of this work is to identify: 1) at- risk patients post-ACLR who are the ideal participants for clinical trials aimed at preventing poor symptomatic and structural outcomes, and 2) when PA or walking biomechanics need to be targeted during the 1st year post- ACLR. This proposal will also provide the PI with the training and mentoring to develop a novel skill set in whole- knee ultrasound imaging, device-based PA monitoring, longitudinal data analyses, and clinical trial design. This training and mentoring will directly lead to an R34 clinical trial planning grant to develop a clinical trial using gait retraining or PA promotion to prevent poor symptomatic or structural outcomes in high-risk patients post-ACLR.

项目概要 美国每年发生约 250,000 例前十字韧带 (ACL) 损伤，主要是 然而，至少有三分之一患有 ACLR 的年轻人的损伤得到了治愈。 手术和手术是关键的生活事件，会导致慢性疼痛、长期生活质量下降和体重增加。 ACLR 后的第一年对于患者的长期结果至关重要，因为存在骨关节炎 (OA) 的风险。 有证据表明，ACLR 术后 1 年内的疼痛水平和生活质量将保持不变 另外，在 ACLR 术后 1 年，约 33% 的年轻人出现膝关节结构性病变。 不幸的是，没有基于证据的策略来识别在 ACLR 后第一年中哪些人是 因此，我们无法识别易感人群并且缺乏。 对哪些可改变的风险因素可以降低风险并预防终身残疾的重要见解。 ACLR 术后第一年常见的潜在可改变风险因素是步行方式的改变 由于症状不佳和放射学前结构不良，生物力学和体力活动水平不足。 病理学是膝关节骨关节炎发展的危险因素，了解与以下相关的可改变的危险因素 ACLR 后第一年的不良症状和结构结果需要未来的研究来确定 预防 OA 的疗法 本研究的目的是确定 PA 和步行的纵向变化。 ACLR 后 3、6、9 和 12 个月评估的生物力学与不良症状或结构结果相关 在 ACLR 后的第一年，这将是第一项将以下结果应用于年轻人的研究。 ACLR 后第一年多次就诊：1) 早期 OA 症状的分类标准，2) 临床 将评估可用于检测多种结构性病变的全膝超声评分系统。 使用研究级加速计来量化每天和每周分钟的中度至剧烈 PA 步数 每次研究访问后的 7 天内，将通过动作捕捉来评估步行生物力学。 实验室量化垂直地面反作用力和内膝内收力矩我的中心假设。 是 PA 和步行生物力学发生适度变化的参与者在 ACLR 后不太可能 与快速发病的人相比，第一年的症状和结构结果较差 PA 和行走生物力学的增加或没有变化 这项工作的预期结果是确定：1​​) at- ACLR 后的风险患者是旨在预防不良症状的临床试验的理想参与者 和结构性结果，以及 2）何时需要在术后第一年针对 PA 或步行生物力学进行目标 ACLR。该提案还将为 PI 提供培训和指导，以全面开发一套新颖的技能。 膝关节超声成像、基于设备的 PA 监测、纵向数据分析和临床试验设计。 培训和指导将直接获得 R34 临床试验规划拨款，用于开发使用步态的临床试验 再训练或 PA 促进，以防止高危患者 ACLR 后出现不良症状或结构性结果。