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

项目摘要/摘要 前十字韧带损伤是创伤后骨关节炎的高危因素 (PTOA)尽管前交叉韧带重建(ACLR)但仍有发展。但是，我们对PTOA发展的理解 在ACLR受到限制后，提供早期诊断和预后的可靠“标志物”(危险因素)仍然存在 缺乏。ACLR术后PTOA的长期研究主要使用X线片来评估结构损伤， 它只提供了仅限于疾病晚期发生的骨骼变化的信息。以前的核磁共振 ACLR后的研究主要局限于短期/中期随访。软组织的长期退化， 它们之间的关系，以及与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，我们的目标是填补这一空白，并建议将形态和定量磁共振成像(QMRI)添加到新的 ACLR后10年来自多中心矫形外科结果网络(MOUNE)的嵌套队列。美国国立卫生研究院 资助的MON研究旨在跟踪ACLR患者手术后的临床结果 包括PTOA的启动和进展的风险因素。月球队列在世界上是独一无二的 &gt；3500名参与者，超过80%的人在2年、6年和10年进行了随访。月球小组已经发表了 对患者报告结果测量(PROMS)的风险因素进行多变量建模，以及 罕见的结果(移植物失败、感染、全膝关节置换术)。此外，一个新的嵌套队列(n=425)是 在月球队列中启动，该队列由年轻的活跃患者组成，进行了全面的研究 评估包括X光片、身体和器械松弛检查以及功能测试。在这 研究中，我们将在嵌套队列中添加最先进的qMRI来评估软骨(厚度和基质 成分T1和T2)，骨骼(3D形状建模)，肌肉(体积和脂肪渗透)，以及其他与OA相关的 损伤。这项研究的首要目标是确定长期结构损伤和关节软骨的特征。 ACLR后的退变，了解其模式及其与患者预后的关系，并确定可修改的 从术前和术后早期时间点预测ACLR术后10年的PTOA。此外， 10年后的MRI测量，如软骨T1R和T2，也将作为未来的潜在预测指标 PTOA的发展(对于那些在10年内没有发展PTOA的人)，ACLR移植物或对侧的失败 前交叉韧带，并在ACLR后20年的月球时间点进行额外的关节镜手术。 这项拟议的研究将利用美国国立卫生研究院资助的月球基金的资源，这是第一次 曾经有机会全面评估膝关节结构损伤及其与患者的相互关系 ACLR术后10年的结果是前瞻性的、特征良好的和密切监测的队列研究。通过识别 ACLR术后10年结构损伤的基线和术后早期可修改的预测因素 这项研究可以立即对改善患者的管理和治疗产生影响，以及铅 进一步对已确定的可改变的危险因素进行随机对照试验，以减少和预防ACLR后的PTOA。

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.