Clinical and Biochemical Predictors of Outcome after Knee Injury in Young Patient

年轻患者膝关节损伤后结果的临床和生化预测因素

• 批准号: 8438387
• 负责人: Christian Lattermann
• 金额: $ 9.81万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-05 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8438387
• 关键词: Adolescent; Age; Anterior Cruciate Ligament; Arthritis; Athletic Injuries; Biochemical; Biological Markers; Bone Injury; Cartilage; Cartilage injury; Characteristics; Clinical; Comorbidity; Contusions; Data; Degenerative polyarthritis; Development; Elderly; Employee Strikes; Enrollment; Film; Goals; Image Analysis; Individual; Injury; Knee; Knee Injuries; Lead; Lesion; Location; Lower Extremity; Magnetic Resonance Imaging; Measures; Operative Surgical Procedures; Outcome; Patient Outcomes Assessments; Patients; Pattern; Physiologic pulse; Population; Postoperative Period; Protocols documentation; Recommendation; Regimen; Rehabilitation therapy; Relative (related person); Reporting; Risk; Seasons; Serum; Severities; Sports; Testing; Time; Universities; Validation; Visual; Vulnerable Populations; Work; anterior cruciate ligament rupture; articular cartilage; bone; cohort; design; disability; early onset; follow-up; high risk; high school; injured; instrument; ligament injury; mammalian COMP; prevent; prospective; young adult

DESCRIPTION (provided by applicant): Posttraumatic osteoarthritis is an acknowledged outcome of contact-related sports injuries but is an underestimated and understudied problem occurring after non-contact rupture of the anterior cruciate ligament (ACL). It is estimated that approximately 40-50% of young athletes are at significant risk for developing progressive osteoarthritis (OA) 10-20 years after ACL injury suffered during high school sports participation. Unfortunately, reliable predictors of which athletes are at highest risk for developing OA after ACL injury do not exist. We propose to establish, for the first time, baseline serum measures of specific biomarkers in 350 injury- free adolescent high school athletes before, during, and after their competitive season (Aim 1). We will follow this cohort of subjects prospectively for 4 years. Simultaneously, we will study a second age- matched cohort of young high school athletes with documented ACL tears. Biomarkers will be measured in these subjects post-injury, until biomarker values normalize. These subjects will be followed for two years post-operatively using patient reported outcome (PRO) instruments. We hypothesize that biomarker levels will increase after ACL injury relative to a normative population. In addition, we hypothesize that biomarkers will be highest in subjects with more severe bone bruising after ACL injury (Aim 2). Finally, we will determine outcomes of subjects with severe bone bruises following ACL injury (Aim 3). The presence of bone bruise is not known to be a predictor of posttraumatic OA and lower clinical outcomes scores, however, bone bruises have been implicated in the progression of osteoarthritis after ACL injury. We will examine if any correlation exists between the magnitude, distribution, or severity of bone bruise, lower patient reported outcomes, and evidence of posttraumatic OA initiation at 2 year follow-up. We will also re-examine pre-operative MRI scans, pre and post-operative standardized x-ray, and patient reported outcomes followed over 2 years (with a follow-up rate of 85%) in a prospective longitudinal cohort of 112 isolated ACL injured patients with no additional comorbidities. Typically, 90-100% of these patients may be expected to have a bone bruise after ACL injury. The impact of these studies is expected to be significant. The identification and validation of biomarkers, with and without supporting correlating data from the extent of bone bruise associated with ACL rupture, will provide clinicians with the means to identify adolescents at high risk for the development of disabling and crippling posttraumatic osteoarthritis and tailor treatment and rehabilitation protocols that may prevent or delay early onset osteoarthritis in this vulnerable population.

描述（由申请人提供）：创伤后的骨关节炎是接触相关运动损伤的公认结果，但是前交叉韧带（ACL）的非接触式破裂后发生的一个被低估和研究的问题。 据估计，大约40-50％的年轻运动员在高中运动期间10 - 20年后10 - 20年遭受了进展性骨关节炎（OA）的巨大风险。不幸的是，在ACL损伤后，哪些运动员有最高风险的可靠预测指标不存在。 我们建议在350名不受伤害的高中运动员中，期间和之后的350名受伤的高中运动员中首次建立特定生物标志物的基线血清测量（AIM 1）。我们将前瞻性地关注这一主题4年。同时，我们将研究第二年年龄段的年轻高中运动员，并记录下来的ACL眼泪。生物标志物将在伤害后的这些受试者中进行测量，直到生物标志物值正常化。 这些受试者将在术后两年内使用患者报告的结果（PRO）仪器进行遵循。我们假设相对于规范人群，ACL损伤后生物标志物水平将增加。此外，我们假设生物标志物在ACL损伤后骨骼更严重的受试者中最高（AIM 2）。 最后，我们将确定ACL损伤后严重骨瘀伤受试者的结果（AIM 3）。骨骼瘀伤的存在并不是创伤后OA的预测指标和较低的临床结局得分，但是，ACL损伤后骨关节炎的进展与骨瘀伤有关。我们将检查骨骼瘀伤的幅度，分布或严重程度，患者报告的结果较低的结果以及2年随访的创伤后OA启动的证据之间是否存在任何相关性。我们还将重新检查术前和术后标准化的X射线术前和术后标准化的X射线扫描，并在112名孤立的ACL受伤的患者的前瞻性纵向队列中，患者报告了2年以上（随访率为85％），没有其他合并症。 通常，这些患者中有90％可能有望在ACL损伤后患有骨瘀伤。 这些研究的影响预计会很大。生物标志物的识别和验证，在有没有支持与ACL破裂相关的骨骼瘀伤程度的情况下有和不支持数据，将为临床医生提供识别出高风险的青少年在残疾和破坏性的创伤后骨骼后骨关节炎，裁缝治疗和恢复治疗方案，以预防早期的弱点或延迟这种情况下，这可能会或延迟这一症状。