Biomechanical Markers of PTOA after ACL Reconstruction and Meniscal Resection

ACL 重建和半月板切除后 PTOA 的生物力学标志物

• 批准号: 10347360
• 负责人: Niccolo M Fiorentino
• 金额: $ 25.93万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-08 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10347360
• 关键词: 3-Dimensional; Address; Ancillary Study; Anterior Cruciate Ligament; Area; Base Composition; Biomechanics; Body Weight; Cartilage; Cartilage Matrix; Catabolism; Collagen; Contralateral; Data; Degenerative polyarthritis; Development; Disease; Disease Progression; Equipment; Event; Excision; Exercise; Exhibits; Femur; Fluoroscopy; Future; Goals; Health; Healthcare Systems; Hyaline Cartilage; Image; Implant; Incidence; Individual; Injury; Intervention; Joints; Knee; Knee joint; Ligaments; Literature; Longitudinal Studies; Magnetic Resonance; Magnetic Resonance Imaging; Maps; Measures; Mechanical Stress; Mechanics; Meniscus structure of joint; Motion; Movement; Onset of illness; Operative Surgical Procedures; Outcome; Parents; Pathogenesis; Patient Recruitments; Patients; Physical Rehabilitation; Physical activity; Proteoglycan; Reconstructive Surgical Procedures; Resolution; Risk; Roentgen Rays; Side; Slide; Speed; Stress; Structure; Techniques; Testing; Therapeutic; Therapeutic Intervention; Thick; Thinness; Time; TimeLine; Tissues; United States; Volition; Width; Work; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; articular cartilage; base; biomechanical test; bone; comparative; cost; early onset; effective therapy; experience; high risk; improved; in vivo; insight; interest; joint biomechanics; knee mechanics; longitudinal analysis; member; meniscus injury; novel; pain reduction; patient population; recruit; repaired; return to sport; skills; targeted treatment; theories; therapeutic target; tibia

Project Summary An estimated 120,000 anterior cruciate ligament (ACL) tears are repaired surgically on an annual basis in the United States. Surgical repair stabilizes the ACL-deficient knee, but a growing body of evidence suggests that surgery does not alter the progression to early-onset osteoarthritis, known as post-traumatic osteoarthritis (PTOA). Patients who undergo anterior cruciate ligament reconstruction (ACLR) are more likely to get PTOA, especially those who sustained a meniscal injury at the same time as their ACL tear. Meniscal resection and removal can have disastrous consequences for patients’ long-term knee joint health. Approximately 21%-48% of patients who had all or part of their meniscus removed during ACLR go on to develop PTOA. Effective treatments for stopping PTOA after meniscal resection have not been conceived because the reasons why the disease develops are not well understood. The theorized mechanism speculates that, despite restoring overall stability, surgical reconstruction of the ACL and resection of the meniscus alter the biomechanics of the knee joint: changing the way cartilage responds to load, shifting the point of contact between tibial and femoral cartilage, increasing the speed at which the tibia and femur bones move past one another during physical activities, and decreasing in the distance between the bones. In turn, sections of cartilage experience unaccustomed loads, and irreversible damage results. Central to this theory is the notion that the bones articulate differently compared to non-surgical knees. While this argument makes sense conceptually, it’s possible that the bones do not articulate differently during physical activity, but instead articular cartilage damage at the time of injury starts a sequence of catabolic events culminating in loss of joint space width—the hallmark outcome of osteoarthritis. The study team members possess the necessary skills, expertise and equipment to support or refute the aforementioned hypothetical framework through direct measurements of biomechanical factors. Specifically, high-speed dual fluoroscopy, an X-ray technique, will measure bone motion with submillimeter and subdegree bias and precision; quantitative magnetic resonance imaging (qMRI) will assess cartilage composition; traditional MRI will quantify three-dimensional cartilage structure. In the current proposal, biomechanical markers for PTOA disease onset and progression will be measured at one and two years after surgery. This longitudinal study will address the following two aims. Aim 1: To improve understanding of PTOA pathogenesis by performing a side-to-side comparative analysis of in-vivo knee mechanics (tibiofemoral cartilage strain and arthrokinematics) in patients one year after ACLR+M. Aim 2: To improve understanding of PTOA pathogenesis by performing an image-based analysis of longitudinal changes in cartilage after ACLR+M. Completion of the aims in this proposal will generate new and impactful insights into PTOA’s accelerated timeline in ACLR+M patients by improving our understanding of the initial events associated with the onset and early progression to PTOA.

项目摘要 据估计，在美国，每年有120，000例前交叉韧带（ACL）撕裂进行手术修复。 美国的手术修复可以稳定ACL缺陷的膝关节，但越来越多的证据表明， 手术并不能改变早发性骨关节炎（即创伤后骨关节炎）的进展 （PTOA）。接受前交叉韧带重建术（ACLR）的患者更容易患PTOA， 特别是那些在ACL撕裂的同时遭受踝关节损伤的人。半月板切除术和 切除可能对患者的长期膝关节健康造成灾难性后果。约21%-48% 的患者在ACLR期间切除了全部或部分半月板，继续发展PTOA。有效 还没有构想出在直肠切除术后停止PTOA的治疗方法， 疾病的发展还不太清楚。理论上的机制推测，尽管恢复了整体 稳定性、ACL的手术重建和半月板切除改变了膝关节的生物力学 关节：改变软骨对负荷的反应方式，改变胫骨和股骨之间的接触点 软骨，增加速度，其中胫骨和股骨骨移动通过彼此在物理过程中 活动，并减少骨骼之间的距离。反过来，软骨部分经历了 不寻常的负载和不可逆转的损害的结果。这一理论的核心观点是 与非手术膝关节相比，关节连接方式不同。虽然这一论点在概念上是有道理的，但它 可能的是，骨骼在身体活动期间没有不同的关节，而是关节软骨 在受伤时的损伤开始了一系列分解代谢事件，最终导致关节间隙宽度的损失， 骨关节炎的标志性结果。研究小组成员具备必要的技能、专业知识和 通过直接测量来支持或反驳上述假设框架的设备 生物力学因素具体来说，高速双透视，一种X射线技术，将测量骨 亚毫米和亚度偏差和精度运动;定量磁共振成像（qMRI） 将评估软骨成分;传统MRI将量化三维软骨结构。在 目前的建议，PTOA疾病发作和进展的生物力学指标将在一个 手术后两年。这项纵向研究将针对以下两个目标。目标1：改善 通过对体内膝关节进行侧对侧比较分析，了解PTOA的发病机制 ACLR+M后1年患者的力学（胫股软骨应变和关节运动学）。目标2： 通过对纵向变化进行基于图像分析，提高对PTOA发病机制的认识 在ACLR+M后的软骨中。完成本提案中的目标将产生新的和有影响力的见解， 通过提高我们对初始事件的理解，加速了ACLR+M患者的PTOA时间轴 与PTOA的发病和早期进展相关。