Multi-faceted Approach Modeling ACL Injury Mechanisms

描述(申请人提供)：前十字韧带(ACL)是膝关节最常见的损伤韧带之一，女性运动员的前十字韧带损伤发生率是男性运动员的2-8倍。前交叉韧带损伤可能是毁灭性的，并从长远来看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，无论治疗方法如何，这些患者在前交叉韧带损伤后10-15年内发生膝骨性关节炎的风险都很高。目前，非接触性前交叉韧带损伤的机制尚不清楚。为了设计成功的前交叉韧带损伤预防方案，并解决女性运动员群体中前交叉韧带损伤的高发生率问题，必须对非接触性前交叉韧带损伤机制有更好的理解。生物力学数据和视频分析都表明，下肢外展负荷的增加可能与前交叉韧带拉伤和受伤风险的增加有关。然而，内侧副韧带(MCL)被认为是抵抗膝关节外展应力的主要约束。临床医生和生物力学专家无法解释为什么没有MCL损伤的前交叉韧带断裂比联合损伤的前交叉韧带断裂更常见。我们假设，在接近全膝关节伸展的情况下，外展和膝关节前关节联合负荷将导致前交叉韧带应变相对于前交叉韧带应变不成比例地增加，并导致前交叉韧带失效载荷，而不伴随有前交叉韧带失效载荷。我们建议使用目前用于研究前交叉韧带损伤机制的独特方法，以获得对高膝关节负荷条件下膝关节韧带生物力学的深入了解。具体地说，我们的目标是通过身体测试、计算机数学建模和三维运动分析来确定前交叉韧带和下前交叉韧带对载荷的机械响应。识别前交叉韧带损伤机制可能有助于我们开发前交叉韧带损伤预防计划，使许多运动员能够从运动中获得健康益处，并避免与膝骨性关节炎相关的长期残疾后遗症。公共卫生相关性：前十字韧带(ACL)损伤可能是毁灭性的，并使运动员长期处于发展成骨关节炎的高风险。不幸的是，手术干预并不能改变受伤后患膝骨性关节炎的几率。我们利用生物力学的方法来确定前交叉韧带损伤的机制，以开发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.