Walk this Way: Physical Activity and Walking Biomechanics Lead to Early Knee OA Symptoms and Ultrasound-Detected Structural Pathology after ACL Reconstruction

以此方式行走：体力活动和行走生物力学导致 ACL 重建后早期膝关节 OA 症状和超声检测的结构病理学

• 批准号: 10506932
• 负责人: Matthew Harkey
• 金额: $ 12.72万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10506932
• 关键词: Accelerometer; Atlases; Biomechanics; Bone Spur; Cartilage; Classification; Clinical; Clinical Trials; Clinical Trials Design; Collaborations; Data Analyses; Degenerative polyarthritis; Development; Diagnosis; Event; Evidence based intervention; Foundations; Future; Grant; Imaging Device; Injury; Joints; Knee; Knee Injuries; Knee Osteoarthritis; Laboratories; Lead; Level of Evidence; Life; Life Experience; Meniscus structure of joint; Mentors; Monitor; Motion; Operative Surgical Procedures; Outcome; Pain quality; Participant; Pathology; Patients; Persons; Physical activity; Popliteal Cyst; Population; Quality of life; Reaction; Reporting; Research; Risk; Risk Factors; Sports Medicine; Standardization; Symptoms; Synovitis; System; Time; Training; Ultrasonography; United States; Visit; Walking; Work; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; base; chronic pain; clinical trial participant; disability; effusion; evidence base; gait rehabilitation; high risk; insight; joint loading; modifiable risk; novel; persistent symptom; prevent; radiological imaging; reconstruction; recruit; skills; ultrasound; young adult

PROJECT SUMMARY About 250,000 anterior cruciate ligament (ACL) injuries occur annually in the United States and are primarily treated with a surgical reconstruction (ACLR). However, for at least 1 in 3 young adults with an ACLR, the injury and surgery are pivotal life events that lead to chronic pain, diminished long-term quality of life, and an increased risk for osteoarthritis (OA). The 1st year post-ACLR is critical to a patient’s long-term outcomes as there is evidence that levels of pain and quality of life experienced at 1 year post-ACLR will remain unchanged for up to 10 years. Additionally, at 1 year post-ACLR, ~33% of young adults present with knee structural pathologies. Unfortunately, there are no evidence-based strategies to identify people during the 1st year post-ACLR who are at risk for chronic symptoms or structural pathology. Hence, we cannot identify susceptible populations and lack critical insights into which modifiable risk factors could decrease their risk and prevent lifelong disability. Potentially modifiable risk factors that are common throughout the 1st year post-ACLR are alterations in walking biomechanics and insufficient levels of physical activity. Since poor symptoms and pre-radiographic structural pathology are risk factors for the development of knee OA, understanding modifiable risk factors that relate to poor symptomatic and structural outcomes during the 1st year post-ACLR is needed for future studies to identify therapies that prevent OA. The objective of this study is to determine how longitudinal changes in PA and walking biomechanics assessed at 3, 6, 9, and 12 months post-ACLR relate to poor symptomatic or structural outcomes during the 1st year post-ACLR. This will be the first study that applies the following outcomes to young adults at multiple visits during the 1st year post-ACLR: 1) classification criteria for early OA symptoms, 2) clinically accessible whole-knee ultrasound scoring system to detect multiple structural pathologies. PA will be assessed with research-grade accelerometers to quantify steps per day and weekly minutes of moderate to vigorous PA during a 7-day period following each study visit. Walking biomechanics will be assessed in a motion capture laboratory to quantify vertical ground reaction force and internal knee adduction moment. My central hypothesis is that participants with a moderate change in PA and walking biomechanics post-ACLR will be less likely to have poor symptomatic and structural outcomes during the 1st year when compared to people with a rapid increase or no change in PA and walking biomechanics. The expected outcome of this work is to identify: 1) at- risk patients post-ACLR who are the ideal participants for clinical trials aimed at preventing poor symptomatic and structural outcomes, and 2) when PA or walking biomechanics need to be targeted during the 1st year post- ACLR. This proposal will also provide the PI with the training and mentoring to develop a novel skill set in whole- knee ultrasound imaging, device-based PA monitoring, longitudinal data analyses, and clinical trial design. This training and mentoring will directly lead to an R34 clinical trial planning grant to develop a clinical trial using gait retraining or PA promotion to prevent poor symptomatic or structural outcomes in high-risk patients post-ACLR.

项目摘要 在美国，每年发生约250，000例前交叉韧带（ACL）损伤，主要是 手术重建（ACLR）。然而，对于至少三分之一患有ACLR的年轻人来说， 和手术是关键的生活事件，导致慢性疼痛，降低长期生活质量， 骨关节炎（OA）的风险。ACLR后第1年对患者的长期结局至关重要，因为 有证据表明ACLR后1年的疼痛水平和生活质量将保持不变， 10年此外，在ACLR后1年，约33%的年轻人出现膝关节结构性病变。 不幸的是，没有基于证据的策略来确定ACLR后第一年的患者， 有慢性症状或结构性病变的风险。因此，我们无法识别易感人群，并且缺乏 对哪些可改变的风险因素可以降低其风险并预防终身残疾的重要见解。 ACLR后第1年内常见的潜在可改变的风险因素是行走的改变 生物力学和身体活动水平不足。由于症状不佳和放射学检查前的结构 病理学是膝关节OA发展的风险因素，了解与以下因素相关的可改变的风险因素： ACLR后第1年的症状和结构结局不佳，需要未来的研究来确定 预防OA的疗法。本研究的目的是确定PA和步行的纵向变化 ACLR后3、6、9和12个月评估的生物力学与不良症状或结构结局相关 在ACLR后的第一年。这将是第一项将以下结果应用于年轻人的研究， ACLR后第1年内的多次访视：1）早期OA症状的分类标准，2）临床 可访问的全膝超声评分系统，以检测多种结构性病变。将对PA进行评估 使用研究级加速计来量化每天的步数和每周中到高强度PA的分钟数 在每次研究访视后的7天内。行走生物力学将在动作捕捉中进行评估 实验室量化垂直地面反作用力和膝内收力矩。我的核心假设是 ACLR后PA和步行生物力学发生中度变化的参与者不太可能 在第一年，与快速死亡的人相比， PA和步行生物力学增加或无变化。这项工作的预期成果是确定：1）在- ACLR后的风险患者，他们是旨在预防不良症状的临床试验的理想参与者 和结构结果，以及2）当PA或步行生物力学需要在术后第1年内成为目标时， ACLR。该提案还将为PI提供培训和指导，以开发一套全新的技能- 膝关节超声成像、基于器械的PA监测、纵向数据分析和临床试验设计。这 培训和指导将直接导致R34临床试验规划补助金，以开发使用步态的临床试验 再培训或PA推广，以预防ACLR后高危患者的不良症状或结构结局。