In vivo ACL Reconstruction Biomechanics

体内 ACL 重建生物力学

• 批准号: 8259529
• 负责人: GUOAN LI
• 金额: $ 37.01万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8259529
• 关键词: Acute; Affect; Age-Years; Anatomic Models; Anatomy; Anterior; Anterior Cruciate Ligament; Biomechanics; Bone Transplantation; Clinic; Clinical; Computer software; Contralateral; Data; Degenerative polyarthritis; Development; Effectiveness; Experimental Designs; Female; Freedom; Gait; Goals; Guidelines; Health; Hospitals; Image; Imaging Techniques; In Vitro; Incidence; Injury; Investigation; Joints; Knee; Knee joint; Knowledge; Lateral; Lead; Long-Term Effects; Magnetic Resonance Imaging; Measures; Mechanics; Medial; Modeling; Motion; Operative Surgical Procedures; Orthopedics; Outpatients; Patient Care; Patients; Physical therapy; Physiological; Pilot Projects; Population; Positioning Attribute; Postoperative Period; Procedures; Protocols documentation; Recruitment Activity; Relative (related person); Reporting; Research; Research Project Grants; Rotation; Series; Solid; Sports Medicine; System; Techniques; Tendon structure; Testing; Time; Translations; United States; Visit; Weight-Bearing state; anterior cruciate ligament reconstruction; articular cartilage; base; bone; follow-up; human subject; improved; in vivo; injured; joint function; kinematics; ligament injury; male; novel; prevent; reconstruction; research study; three-dimensional modeling; time interval

DESCRIPTION (provided by applicant): Despite the numerous reports on the successful results of ACL reconstruction, upwards of 40% of ACL reconstruction patients have abnormal laxity and undergo revision surgery. Moreover, ACL reconstruction does not reduce the rate of osteoarthritis when compared to more conservative treatments. There is little quantitative data demonstrating how ACL deficiency alters in-vivo knee kinematics in six degrees-of-freedom (6DOF) and how the contemporary ACL reconstruction restores the altered knee kinematics in 6DOF under in-vivo physiological loading conditions. Further, no data has been reported on how the combined meniscal injury will affect the in-vivo function of the ACL reconstructed knees. The first aim of this project is to compare the in-vivo biomechanics of healthy and acute ACL-injured knees within the same subject using a novel imaging technique. Three-dimensional (3D) knee models of human subjects will be created from MR images. These models will then be matched to a series of dual fluoroscopic image sets to accurately reproduce the kinematics of the knee during activities such as stair ascent/descent, gait and weight-bearing flexion-extension. The effects of combined meniscal damage to the ACL-injured knee will be determined directly from the three-dimensional knee models as well. The second aim of this project is to investigate the patients after ACL reconstruction surgery in a long-term follow-up study. To quantify the biomechanical effects of ACL reconstruction and a combined meniscal injury towards the efficacy of ACL reconstruction, the same patients from the first aim will return two times over a three year period, at 6 and 36 months following ACL reconstruction, for additional fluoroscopic imaging. ACL-reconstructed patients will be divided into three groups, those with no meniscal injury, those with medial meniscal tears, and those with lateral meniscal tears. The ACL- reconstructed knees will be tested again during the same in-vivo functional activities performed in the first aim, and 6DOF knee kinematics will be measured. The effect of combined meniscal tear on knee joint kinematics after ACL reconstruction will be analyzed quantitatively. The proposed study is a unique approach to one of the most important clinical problems in Sports Medicine Surgery. Our easy and powerful analysis technique will provide a thorough understanding of the effects of the combined ACL and meniscal injury on the 6DOF in-vivo dynamic knee joint function. The long-term follow up data will further elucidate the efficacy of contemporary ACL reconstruction in restoring normal knee function. This knowledge will lead to an improved patient care, as a guideline can be developed for new ACL reconstruction techniques that more accurately reproduce the normal in-vivo knee kinematics. In restoring the normal physiological functions of the knee joint and thereby preventing long-term joint degeneration, the need for frequent hospital visits, excessive physical therapy, and revision surgery - all inherent to the current practice - could be reduced. PUBLIC HEALTH RELEVANCE. This investigation will measure the six degrees-of-freedom knee kinematics of patients before and after anterior cruciate ligament (ACL) reconstruction in a longitudinal experimental design. The effects of combined meniscal injury on the efficacy of ACL reconstruction will also be analyzed. The knowledge gained from this study will provide a general, quantitative biomechanical guideline for developing new surgical treatments of ACL injuries, thereby restoring long term joint stability and preventing joint degeneration after surgical reconstruction of the injured ACL.

描述（由申请人提供）：尽管有许多有关ACL重建成功结果的报道，但超过40％的ACL重建患者的疏松率异常，并且接受了修订手术。此外，与更保守的治疗相比，ACL重建并不能降低骨关节炎的率。几乎没有定量数据表明，ACL缺乏症如何在六个自由度（6DOF）中改变体内膝关节运动，以及当代ACL重建如何恢复6DOF中改变的膝关节动力学的变化。此外，尚无关于半月板损伤如何影响ACL重建膝盖的体内功能的数据。该项目的第一个目的是使用一种新型的成像技术比较同一受试者中健康和急性ACL损伤膝盖的体内生物力学。人类受试者的三维（3D）膝盖模型将由MR图像创建。然后，这些模型将与一系列双重荧光图像集匹配，以在阶梯上升/下降，步态和体重屈曲延伸等活动期间准确地重现膝盖的运动学。半月板损伤对ACL损伤膝关节的影响将直接从三维膝盖模型确定。该项目的第二个目的是在一项长期随访研究中调查ACL重建手术后的患者。为了量化ACL重建的生物力学作用和对ACL重建功效的半月板损伤的综合损伤，第一个目标的同一患者将在ACL重建后6和36个月内两次返回两次，以进行其他荧光成像。 ACL重建的患者将分为三组，没有半月板损伤的患者，内侧半月板撕裂的患者以及横向半月板眼泪的患者。在第一个目标中执行的同一体内功能活动中，将再次测试ACL重建的膝盖，并测量6DOF膝盖运动学。半月板撕裂对ACL重建后膝关节运动学的影响将进行定量分析。拟议的研究是针对运动医学手术中最重要的临床问题之一的独特方法。我们简单而强大的分析技术将对联合ACL和半月板损伤对6DOF体内动态膝关节功能的影响提供深入的了解。长期的随访数据将进一步阐明当代ACL重建在恢复正常膝关节功能方面的功效。这些知识将导致改善患者护理，因为可以针对新的ACL重建技术制定指南，从而更准确地重现正常的体内膝关节运动学。在恢复膝关节的正常生理功能并防止长期关节变性，需要频繁就诊，过度的物理治疗和修订手术（所有这些都是当前做法固有的）的需求。公共卫生相关性。这项研究将测量纵向实验设计中前后韧带（ACL）重建前后患者的六个自由度的膝关节运动学。也将分析半月板损伤对ACL重建功效的影响。从这项研究中获得的知识将为开发新的ACL损伤手术治疗方法提供一般的，定量的生物力学指南，从而恢复长期关节稳定性并防止受伤ACL手术重建后的关节变性。

项目成果

The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint.

• DOI: 10.1177/0363546511434276
• 发表时间: 2012-04
• 期刊: The American journal of sports medicine
• 作者: Gadikota HR;Sim JA;Hosseini A;Gill TJ;Li G
• 通讯作者: Li G

Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces.

单束和双束前交叉韧带重建在膝关节运动学和前交叉韧带力恢复方面的比较。

• DOI: 10.1177/0363546510361494
• 发表时间: 2010
• 期刊: The American journal of sports medicine
• 作者: Seon,JongKeun;Gadikota,HemanthR;Wu,Jia-Lin;Sutton,Karen;Gill,ThomasJ;Li,Guoan
• 通讯作者: Li,Guoan

Short-Term Contact Kinematic Changes and Longer-Term Biochemical Changes in the Cartilage After ACL Reconstruction: A Pilot Study.

• DOI: 10.1007/s10439-018-2079-6
• 发表时间: 2018-11
• 期刊: Annals of biomedical engineering
• 影响因子: 3.8
• 作者: Li G;Li JS;Torriani M;Hosseini A
• 通讯作者: Hosseini A

Anterior cruciate ligament reconstruction and cartilage contact forces--A 3D computational simulation.

• DOI: 10.1016/j.clinbiomech.2015.08.007
• 发表时间: 2015-12
• 期刊: Clinical biomechanics (Bristol, Avon)
• 作者: Wang L;Lin L;Feng Y;Fernandes TL;Asnis P;Hosseini A;Li G
• 通讯作者: Li G

Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques.

• DOI: 10.1177/0363546511420810
• 发表时间: 2011-12
• 期刊: The American journal of sports medicine
• 作者: Sim JA;Gadikota HR;Li JS;Li G;Gill TJ
• 通讯作者: Gill TJ