Multi-faceted Approach Modeling ACL Injury Mechanisms

描述（由申请人提供）：前交叉韧带（ACL）是膝关节最常见的韧带损伤之一，女运动员的ACL损伤率是男运动员的2-8倍。前交叉韧带损伤可能是毁灭性的，并且会显著增加运动员患骨关节炎的风险。虽然在前交叉韧带损伤患者的手术和康复治疗方面取得了许多进展，但长期结果研究表明，这些患者在前交叉韧带损伤后10-15年发生膝骨关节炎的风险很高，无论治疗如何。目前，非接触性前交叉韧带损伤的机制尚不清楚。为了设计成功的ACL损伤预防方案，解决女性运动员中ACL损伤高发的问题，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表明，下肢外展负荷的增加可能与前交叉韧带劳损和损伤风险的增加有关。然而，内侧副韧带（MCL）被认为是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没有中交叉韧带损伤的前交叉韧带断裂明显比前交叉韧带/中交叉韧带合并损伤更常见。我们假设，在女性运动员中，膝关节完全伸展时，膝关节外展和膝关节前负荷的耦合将导致ACL应变相对于MCL应变不成比例的增加，并导致没有伴随MCL失效负荷的ACL失效负荷。我们建议使用一种独特的混合现有方法来研究前交叉韧带损伤机制，以便在高膝关节负荷条件下深入了解膝关节韧带的生物力学。具体来说，我们的目标是通过尸体试验、计算机数学建模和三维运动分析来确定前交叉韧带和中交叉韧带对载荷的力学响应。确定前交叉韧带损伤机制可以帮助我们制定前交叉韧带损伤预防计划，这将使许多运动员获得运动参与的健康益处，并避免与膝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，并使运动员长期处于患骨关节炎的高风险中。不幸的是，手术干预并不能改变损伤后发生膝骨关节炎的几率。我们利用生物力学方法来确定前交叉韧带损伤的机制，以便制定有效的干预措施来预防前交叉韧带损伤。

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.