The In Vivo Biomechanics of Lateral Ankle Ligament Injury and Reconstruction

描述（由申请人提供）： 踝关节外侧韧带扭伤是运动和娱乐中最常见的损伤之一。尽管许多外侧踝关节扭伤患者的临床结局良好，但长期随访研究报告称，10%至40%的患者出现慢性症状，包括不稳定、疼痛和骨关节炎。运动学异常被认为有助于骨关节炎的发展，但确切的机制仍不清楚。踝关节外侧韧带损伤对体内关节运动学和关节接触的影响尚不清楚。为了恢复正常的关节运动和减缓骨关节炎的发展，作者提倡对踝关节外侧韧带进行手术重建。然而，踝关节外侧韧带损伤的适当手术治疗仍然存在争议，文献中描述了80多种不同的重建技术。长期随访研究表明，踝关节外侧韧带重建后骨关节炎的发生率较高。尽管文献中描述了许多技术，但在功能负荷条件下重建恢复正常关节力学的能力尚不清楚。本建议的目的是测量踝关节外侧韧带损伤后体内关节运动学的变化，使用对侧踝关节作为对照。将使用视频步态分析和正交荧光透视和磁共振成像技术在几个负重活动期间评估患者的踝关节运动。此外，将使用荧光透视和磁共振成像技术来量化踝关节外侧韧带损伤对体内软骨接触应变峰值的大小和位置的影响。最后，将在术后6个月和12个月测量手术重建对运动学和接触应变的影响。这项研究将直接比较在体内的运动学和关节接触应变的损伤踝关节的完整踝关节。这些数据将有助于阐明踝关节外侧韧带断裂患者退行性变化的机制。此外，将评估手术重建对关节力学的影响。这些数据可用于优化外踝韧带的手术重建技术。慢性踝关节外侧扭伤的适当治疗仍然存在争议。本研究的目的是量化踝关节外侧韧带损伤患者手术重建前后的关节运动和软骨接触应变分布。这些数据将有助于确定这些损伤后导致关节退化的机制，并可能导致更好的重建技术。

DESCRIPTION (provided by applicant): Sprains of the lateral ligaments of the ankle are one of the most common injuries in sports and recreation. Although many patients with lateral ankle sprains have good clinical outcomes, long term follow-up studies have reported that between 10 to 40% of patients experience chronic symptoms including instability, pain, and osteoarthritis. Abnormal kinematics have been thought to contribute to the development of osteoarthritis, but the precise mechanisms remain unclear. The effects of lateral ankle ligament injury on in vivo joint kinematics and articular contact are not well understood. In an effort to restore normal joint motion and slow the development of osteoarthritis, authors have advocated surgical reconstruction of the lateral ankle ligaments. However, the appropriate surgical treatment of lateral ankle ligament injuries remains controversial, with more than 80 different reconstruction techniques described in the literature. Long-term follow-up studies indicate that there is a high incidence of osteoarthritis after reconstruction of the lateral ankle ligaments. Despite the many techniques described in the literature, the ability of reconstruction to restore normal joint mechanics under functional loading conditions is unknown. The objective of this proposal is to measure the change in in vivo joint kinematics after lateral ankle ligament injuries, using the contralateral ankle joint as a control. The ankle motion of the patients will be evaluated during several weight-bearing activities using both a video gait analysis and an orthogonal fluoroscopic and magnetic resonance imaging technique. In addition, the fluoroscopic and magnetic resonance imaging technique will be used to quantify the effects of lateral ankle ligament injury on magnitude and location of the peak in vivo cartilage contact strains. Finally, the effects of surgical reconstruction on kinematics and contact strains will be measured at 6 and 12 months post-operatively. This study will directly compare the in vivo kinematics and joint contact strains of the injured ankle to that of the intact ankle. These data will help to elucidate the mechanisms contributing to degenerative changes in patients with patients with lateral ankle ligament rupture. Furthermore, the effects of surgical reconstruction on joint mechanics will be evaluated. These data may be used to optimize surgical reconstruction techniques of the lateral ankle ligaments. The appropriate treatment of chronic lateral ankle sprains remains controversial. The aim of this study is to quantify the joint motion and cartilage contact strain distributions of patients with lateral ankle ligament injuries before and after surgical reconstruction. These data will help to identify mechanisms leading to joint degeneration after these injuries and may lead to better reconstruction techniques.