Quadriceps Muscle Quality: A Post-Injury Determinant of Knee Function and Health

股四头肌肌肉质量：膝关节功能和健康的损伤后决定因素

• 批准号: 10743396
• 负责人: Brian Pietrosimone
• 金额: $ 27.37万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-26 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10743396
• 关键词: Acute; Address; Affect; American; Area; Biomechanics; Cartilage; Clinical; Clinical Trials; Contracts; Data; Development; Disease; Economic Burden; Evaluation; Extensor; Functional disorder; Gait; Goals; Health; Imaging Techniques; Impairment; Individual; Infrastructure; Injury; Intervention; Investments; Joints; Knee; Knee Injuries; Knee Osteoarthritis; Limb structure; Link; Magnetic Resonance Imaging; Measurement; Measures; Medical Research; Medicine; Mission; Movement; Muscle; Muscle function; Muscular Atrophy; Operative Surgical Procedures; Outcome; Parents; Pathway interactions; Patient Outcomes Assessments; Patients; Physical Function; Physical Performance; Prognosis; Public Health; Randomized; Rehabilitation Outcome; Rehabilitation therapy; Relaxation; Research; Risk; Risk Reduction; Role; Sample Size; Signal Transduction; Techniques; Testing; Therapeutic exercise; Time; Tissue imaging; Tissues; Ultrasonography; United States National Institutes of Health; Work; anterior cruciate ligament injury; articular cartilage; burden of illness; cost effective intervention; improved; innovation; insight; long-term sequelae; next generation; novel; post-operative rehabilitation; quadriceps muscle; reconstruction; rehabilitation strategy; success; treatment strategy; vibration

Abstract Persistent quadriceps muscle dysfunction following anterior cruciate ligament (ACL) injury and reconstruction (ACLR) is a critical clinical concern impacting the success of postoperative rehabilitation and prognosis of long- term joint health. Our novel working hypothesis is that worse quadriceps muscle quality, caused by a progressive increase in non-contractile tissue within the muscle, post-ACL injury and ACLR is a critical and understudied mechanism underlying poor clinical outcomes. There is a significant scientific gap in our understanding of the mechanistic pathway linking changes in quadriceps muscle quality to poor clinical outcomes. Our preliminary work using ultrasonography to assess changes in muscle quality supports our working hypothesis, in that patients with an ACL injury demonstrate muscle tissue image signal changes consistent with increased non- contractile tissue makeup in the first 3 months post-ACLR. Furthermore, ultrasonographic muscle tissue signal changes are associated with lesser knee extensor strength and worse physical performance (i.e., hop testing). Unfortunately, rigorous studies to test our working hypothesis have not been conducted to comprehensively evaluate the effect of ACL injury on muscle quality and the impact of poorer muscle quality on clinical outcomes. Recent magnetic resonance imaging (MRI) innovations now allow for high-precision and rapid evaluation of muscle quality throughout the entire muscle volume and in individual quadricep heads. We can be opportunistic and leverage an ongoing rehabilitation-based parent clinical trial already collecting critical clinical outcomes of knee extensor strength, gait biomechanics, physical performance and patient-reported outcomes (PRO), and tibiofemoral cartilage composition at preoperative, and 1-, 6-, and 12-month post-ACLR timepoints. We are proposing to test our working hypothesis with an ancillary R21 by conducting the following specific aims: 1) determine longitudinal changes in quadriceps muscle quality following ACL injury and ACLR preoperatively and at 1-, 6- and 12-months post-ACLR; and 2) determine the associations between changes in muscle quality and a) knee extensor strength; b) gait biomechanics; c) PRO and physical performance; and d) tibiofemoral cartilage composition. Our study is innovative as: 1) we are testing a novel hypothesis that quadriceps muscle quality changes early post-ACL injury and that it is a critical mechanism associated with poor clinical outcomes; 2) we are utilizing a novel MRI technique capable of collecting highly-sensitive measures of muscle quality in individual heads of the quadriceps throughout the entire muscle volume; and 3) associations between muscle quality and a comprehensive host of clinical outcomes (i.e. knee extensor strength, gait biomechanics, physical performance and PRO, and tibiofemoral cartilage composition) can be evaluated as part of the ancillary R21. The proposed R21 is significant as identifying the association between deleterious changes in muscle quality and poor clinical outcomes is the first critical step in developing the next generation of interventions to address the underlying mechanistic muscular changes leading to poor outcomes following ACL injury and ACLR.

抽象的 前交叉韧带（ACL）损伤和重建后持续的股四头肌肌肉功能障碍 （ACLR）是影响术后康复成功和长期预后成功的关键临床关注 任期联合健康。我们新颖的工作假设是，股四头肌的肌肉质量更糟 肌肉内的非收缩组织增加，ACL后损伤和ACLR是关键而研究的 临床结果不佳的机制。我们对 机械途径将股四头肌肌肉质量变化与临床结果不佳的变化联系起来。我们的初步 使用超声检查评估肌肉质量变化的工作支持我们的工作假设，这是 ACL损伤的患者表明肌肉组织图像信号信号变化与非非 - ACLR后最初三个月的收缩组织化妆。此外，超声学肌肉组织信号 变化与较小的膝关节伸肌强度和身体表现较差有关（即跳跃测试）。 不幸的是，尚未对我们的工作假设进行严格的研究 评估ACL损伤对肌肉质量的影响以及较差的肌肉质量对临床结果的影响。 最近的磁共振成像（MRI）创新现在可以进行高精度和快速评估 肌肉质量在整个肌肉体积和单个股四头肌头部。我们可以成为机会主义 并利用正在进行的基于康复的父母临床试验已经收集关键的临床结果 膝盖伸肌力量，步态生物力学，身体表现和患者报告的结果（Pro）和 术前的胫骨软骨组成以及1个月和12个月后的ACLR时间点。我们是 提出通过执行以下特定目的来检验我们的工作假设：1） 在ACL损伤和术前ACLR和ACLR后，确定股四头肌肌肉质量的纵向变化 ACLR后1，6个月和12个月； 2）确定肌肉质量变化与 a）膝盖伸肌的力量； b）步态生物力学； c）专业和身体表现； d）胫骨软骨 作品。我们的研究具有创新性，如：1）我们正在测试一个新的假设，即股四头肌肌肉质量 改变后ACL损伤的早期损伤，是与临床不良结局相关的关键机制； 2）我们 正在利用一种能够收集个体肌肉质量高度敏感的肌肉质量的新型MRI技术 整个肌肉体积的股四头肌头； 3）肌肉质量与 全面的临床结果（即膝盖伸肌力量，步态生物力学，身体表现） 可以作为辅助R21的一部分评估Pro和胫骨软骨组成）。提议 R21意义重大，因为确定肌肉质量有害变化与临床差的不良变化之间的关联 成果是开发下一代干预措施以解决基础的第一步 机械性肌肉变化导致ACL损伤和ACLR后结果不佳。