Multi-faceted Approach Modeling ACL Injury Mechanisms

描述（由申请人提供）：前交叉韧带（ACL）是最常见的膝关节韧带损伤之一，女性运动员ACL损伤的发生率是男性运动员的2-8倍。ACL损伤可能是毁灭性的，并显着增加运动员患骨关节炎的长期风险。虽然在ACL损伤患者的手术和康复治疗方面已经取得了许多进展，但长期结局研究表明，这些患者在ACL损伤后10-15年发生膝关节骨关节炎的风险很高，无论治疗如何。目前，非接触性ACL损伤的机制还不清楚。为了设计成功的ACL损伤预防方案并解决女性运动员人群中ACL损伤的高发生率，必须更好地了解非接触性ACL损伤机制。生物力学数据和视频分析均表明，下肢外展负荷增加可能与ACL应变增加和损伤风险增加相关。然而，内侧副韧带（MCL）被认为是对膝关节外展应力的主要约束。临床医生和生物力学家无法解释为什么ACL断裂而没有MCL损伤明显比ACL/MCL联合损伤更常见。我们假设，耦合外展和前膝关节负荷接近全膝伸展将导致ACL应变相对于MCL应变不成比例地增加，并导致ACL失效负荷，而不伴随MCL失效负荷的女性运动员。我们建议使用一个独特的混合目前的方法来调查ACL损伤机制，以获得在膝关节高负荷条件下的膝关节韧带生物力学的深入了解。具体而言，我们的目标是确定ACL和MCL的机械响应负载使用尸体测试，计算机数学建模和三维运动分析。确定ACL损伤机制可能有助于我们制定ACL损伤预防计划，使许多运动员能够获得运动参与的健康益处，并避免与膝关节骨关节炎相关的残疾的长期后遗症。公共卫生相关性：前交叉韧带（ACL）损伤可能是毁灭性的，并将运动员置于长期发展骨关节炎的高风险中。不幸的是，手术干预并不能改变受伤后发生膝关节骨关节炎的几率。我们利用生物力学的方法来确定ACL损伤的机制，以制定有效的干预措施，以防止ACL损伤。

DESCRIPTION (provided by applicant): The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee, with female athletes sustaining ACL injuries at a 2-8 fold greater rate compared to male athletes. An ACL injury can be devastating and significantly increases the athlete's risk for osteoarthritis long term. While many advances have been made in terms of surgical and rehabilitation treatments for ACL injured patients, long term outcome studies show that these patients are at a high risk for developing knee osteoarthritis 10-15 years after ACL injury regardless of the treatment. Currently, the mechanism of non-contact ACL injury is not well understood. In order to design successful ACL injury prevention programs and address the high rates of ACL injuries in the female athlete population, a better understanding of the non-contact ACL injury mechanism must be established. Both biomechanical data and video analyses indicate that increased abduction loads in the lower extremities may be associated with increased ACL strain and risk of injury. However, the medial collateral ligament (MCL) is considered to be the primary restraint against abduction stress in the knee joint. Clinicians and biomechanists are unable to explain why ACL ruptures without MCL injuries are significantly more common than combined ACL/MCL injuries. We hypothesize that coupled abduction and anterior knee joint loads near full knee extension will lead to disproportional increases in ACL strain relative to MCL strain and lead to ACL failure loads without concomitant MCL failure loads in female athletes. We propose to use a unique blend of the current methods used to investigate ACL injury mechanisms in order to gain an in depth understanding of knee ligament biomechanics during high knee loading conditions. Specifically, we aim to determine the mechanical responses of the ACL and MCL to loads using cadaveric testing, computer mathematical modeling, and three-dimensional motion analysis. Identifying ACL injury mechanisms may help us develop ACL injury prevention programs that would allow many athletes to receive the health benefits of sports participation and avoid the long term sequelae of disability associated with knee osteoarthritis. PUBLIC HEALTH RELEVANCE: An anterior cruciate ligament (ACL) injury can be devastating and places an athlete at a high risk of developing osteoarthritis long term. Unfortunately, surgical intervention does not change the odds of developing knee osteoarthritis after injury. We utilize biomechanical methods to identify mechanisms of ACL injury in order to develop effective interventions to prevent ACL injury.