Imaging post-traumatic osteoarthritis 10-years after ACL reconstruction: a multicenter cohort study with quantitative MRI

ACL 重建 10 年后创伤后骨关节炎的影像学：定量 MRI 的多中心队列研究

• 批准号: 10878519
• 负责人: Xiaojuan Li
• 金额: $ 68.38万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-16 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10878519
• 关键词: 3-Dimensional; Age; Anterior Cruciate Ligament; Area; Arthroscopic Surgical Procedures; Body mass index; Cartilage; Cartilage injury; Clinical; Cohort Studies; Contralateral; Data; Development; Disease; Early Diagnosis; Evaluation Research; Failure; Funding; Future; Gender; Goals; Grant; Image; Infection; Infiltration; Joints; Knee; Lead; Lesion; Longitudinal Studies; Magnetic Resonance Imaging; Maps; Measures; Meniscus structure of joint; Modeling; Monitor; Morphology; Muscle; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Peptide Initiation Factors; Postoperative Period; Prognosis; Publishing; Qualifying; Research Personnel; Resources; Risk Factors; SF-36; Scientist; Shapes; Side; Standardization; Symptoms; Techniques; Testing; Thick; Time; Training; Traumatic Arthropathy; United States National Institutes of Health; Width; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; articular cartilage; bone; cartilage degradation; clinical imaging; cohort; design; follow-up; graft failure; high risk; improved; instrument; joint destruction; knee replacement arthroplasty; meniscal tear; meniscus injury; modifiable risk; novel; prevent; prospective; quantitative imaging; randomized, clinical trials; reconstruction; soft tissue

PROJECT SUMMARY/ABSTRACT Anterior Cruciate Ligament (ACL) injury is a proven high-risk factor for post-traumatic osteoarthritis (PTOA) development despite ACL reconstruction (ACLR). However, our understanding of PTOA development after ACLR is limited, and reliable “markers” (risk factors) that provide early diagnosis and prognosis are still lacking. Long-term studies of PTOA after ACLR primarily used radiographs for evaluating structural damage, which only provided information limited to bone changes that occur at late stages of the disease. Previous MRI studies after ACLR are primarily limited to short/mid-term follow up. The long-term degeneration of soft tissue, their relationship to each other, and to patient symptoms and outcomes after ACLR are largely unknown. In this study, we aim to fill this gap and propose to add morphologic and quantitative MRI (qMRI) to the novel nested cohort from the Multicenter Orthopaedic Outcomes Network (MOON) at 10 years after ACLR. The NIH funded MOON study was designed to follow ACLR patients after surgery to determine their clinical outcomes including risk factors for the initiation and progression of PTOA. The MOON cohort is unique in the world with >3500 participants and greater than 80% follow-up at 2, 6, and 10 years. The MOON group has published extensively on multivariable modeling on risk factors for patient reported outcomes measures (PROMs), and infrequent outcomes (graft failure, infection, total knee arthroplasty). Further, a novel nested cohort (n=425) was initiated within the MOON cohort which consists of young active patients with a comprehensive research evaluation including radiographs, physical and instrumented laxity examination, and functional testing. In this study, we will add state-of-the-art qMRI to this nested cohort to evaluate cartilage (thickness and matrix composition T1r and T2), bone (3D shape modeling), muscle (volume and fatty infiltration), and other OA-related lesions. The overarching goal of the study is to characterize long-term structural damage and articular cartilage degeneration after ACLR, understand their patterns and relationship to patient outcomes, and identify modifiable predictors for PTOA at 10 years after ACLR from pre-operative and early postoperative time points. Furthermore, the MRI measures, such as cartilage T1r and T2, at 10 years will also serve as potential predictors for future PTOA development (for those who do not develop PTOA at 10 years), failure of the ACLR graft or contralateral ACL, and additional arthroscopic surgery at the 20 years post-ACLR MOON time point. The proposed study will leverage resources from the NIH funded MOON grant, and this is a unique, first ever, opportunity to comprehensively evaluate the knee structural damage and their interrelationship with patient outcomes at 10 years after ACLR in a prospective, well characterized and closely monitored cohort. By identifying modifiable predictors of structural damage at 10 years after ACLR from baseline and early postoperative time points, this study can have immediate impact on improving patient management and treatment, as well as lead to further RCT on identified modifiable risk factors to reduce and prevent PTOA following ACLR.

项目摘要/摘要 前交叉韧带（ACL）损伤是创伤后骨关节炎的被证明的高风险因素 （PTOA）开发任务ACL重建（ACLR）。但是，我们对PTOA开发的理解 在ACLR受到限制之后，可靠的“标记”（风险因素）提供了早期诊断和预后 缺乏。 ACLR后PTOA的长期研究主要使用X光片评估结构损伤， 仅提供仅限于疾病晚期发生的骨变化的信息。以前的MRI ACLR后的研究主要仅限于短期/中期随访。软组织的长期变性， 它们彼此之间的关系以及ACLR后患者症状和结果的关系在很大程度上是未知的。 在这项研究中，我们旨在填补这一空白和提议，以将形态学和定量MRI（QMRI）添加到新颖 ACLR 10年后，来自多中心骨科结局网络（月球）的嵌套队列。 NIH 资助的月球研究旨在跟踪手术后的ACLR患者，以确定其临床结果 包括PTOA主动性和进展的风险因素。月亮队列在世界上是独一无二的 > 3500名参与者，在2、6和10年中大于80％的随访。月亮群已经出版了 关于患者报告的结果措施（PROM）的风险因素的多变量建模和广泛的建模 不常见的结果（移植失败，感染，总膝关节置换术）。此外，一个新颖的嵌套队列（n = 425）是 在月球队列内开始，由年轻的活跃患者组成，并进行全面研究 评估包括X光片，物理和仪器的松弛检查以及功能测试。在这个 研究，我们将在此嵌套队列中添加最先进的QMRI以评估软骨（厚度和矩阵 组成T1R和T2），骨（3D形状建模），肌肉（体积和脂肪浸润）以及其他与OA相关的 病变。该研究的总体目标是表征长期结构损害和关节软骨 ACLR后的退化，了解其模式和与患者结局的关系，并确定可修改 术前和术后时间点ACLR后10年的PTOA预测因子。此外， 10年时的MRI测量（例如软骨T1R和T2）也将作为未来的潜在预测因子 PTOA开发（对于那些在10年不开发PTOA的人），ACLR移植或对侧的失败 ACL和ACLR月亮时间点20年的其他关节镜手术。 拟议的研究将利用NIH资助的月亮赠款的资源，这是一个独特的，首先 有机会全面评估膝盖结构损伤及其与患者的相互关系 ACLR后10年的结果在一个前瞻性，特征且受到密切监测的队列中。通过识别 基线和术后早期ACLR后10年的结构损伤的可修改预测指标 要点，这项研究可能会立即对改善患者的管理和治疗以及铅产生影响 进一步对确定的可修改风险因素进行RCT，以减少和防止ACLR后PTOA。