Supplement to Novel precision medicine approach to advance rehabilitation of surgically repaired tendons of the hand

项目摘要 没有共识或强有力的证据表明，确定最佳的康复协议，以优化结果 用于手部屈肌腱撕裂的手术修复患者。功能恢复成功 需要肌腱接合、不受阻碍的肌腱滑动和修复肌腱的足够抗张强度。 由于有限的证据和实践中的变化，不良愈合结果（例如，肌腱断裂，瘢痕 粘连）发生在相当数量的患者中;一些患者需要二次手术， 成本高，效率低，而且往往是可以预防的。通过该奖学金进行的培训和研究 将支持在三个主要领域的熟练程度有关加强恢复过程：1）肌肉骨骼 超声检查; 2）肌腱愈合的形态学过程; 3）研究方法和数据分析 技术.本研究将使用超声检查肌腱接合的形态学生物标志物， 显像超声成像是一种相对便宜，广泛使用，非侵入性和无痛成像 提供皮下解剖结构的实时图像的模态。超声波已经被用于 评估健康和受伤的肌腱，超声测量已被证明与功能相关 结果。然而，利用这些生物标志物来告知临床实践的方法尚未完全确定。 开发或部署。因此，本项目旨在为超声的应用奠定基础， 成像，以帮助和促进屈肌腱的康复。作为第一步，一个标准化的，可靠的， 将开发有效的超声成像方案来评估肌腱愈合。静态和动态 将探索成像技术来识别各种候选生物标志物，包括宏观形态学 肌腱间隙和粘连的测量，以及使用空间频率的微观形态测量 分析.启动数据收集的时间和频率，以充分捕获愈合过程中的变化 肌腱将被探索，以确定如何成像生物标志物可用于监测恢复模式， 描述肌腱愈合的过程。建立可靠的图像分析协议并识别 最突出的生物标志物将是理解促进肌腱愈合的因素的关键一步， 有效的恢复。成功地实现这些目标将有助于推进实践， 支持肌腱康复的精确医学方法的发展。

Project Summary There is no consensus nor strong evidence that identifies the best rehabilitative protocol to optimize outcomes for patients with surgical repair of a lacerated flexor tendon of the hand. Successful functional recovery requires tendon coaptation, unimpeded tendon gliding, and adequate tensile strength of the repaired tendon. Due to limited evidence and variation in practice, adverse healing outcomes (e.g., tendon ruptures, scar adhesions) occur in a significant number of patients; some patients require a secondary surgery which is costly, less effective, and oftentimes preventable. The training and research conducted through this fellowship will support proficiency in three primary areas related to enhancing the recovery process: 1) musculoskeletal sonography, 2) morphological process of tendon healing, and 3) research methods and data analytic techniques. This fellowship will examine morphologic biomarkers of tendon coaptation using sonographic imaging. Sonographic imaging is a relatively inexpensive, widely available, non-invasive, and pain-free imaging modality that provides real-time images of anatomical structures under the skin. Sonography has been used to evaluate healthy and injured tendons, and sonographic measures have been shown to correlate with functional outcomes. However, an approach for utilizing these biomarkers to inform clinical practice has yet to be fully developed or deployed. As such, this project aims to establish a foundation for the application of sonographic imaging to aid and advance the rehabilitation of flexor tendons. As a first step, a standardized, reliable, and valid sonographic imaging protocol to evaluate tendon healing will be developed. Both static and dynamic imaging techniques will be explored to identify various candidate biomarkers, including macro-morphologic measures of tendon gapping and adhesions, as well as micro-morphologic measures using spatial frequency analysis. The timing for initiation and frequency of data collection to adequately capture changes in the healing tendon will be explored to determine how imaging biomarkers can be used to monitor recovery patterns and characterize the process of tendon healing. Establishing a reliable image analysis protocol and identifying the most salient biomarkers will be a critical step to understanding factors that promote tendon healing with safe and efficient recovery. Successfully accomplishing these aims will be instrumental in advancing practice by supporting the development of a precision medicine approach to tendon rehabilitation.