Multi-faceted Approach to Modeling ACL Injury Mechanisms

ACL 损伤机制建模的多方面方法

• 批准号: 8911250
• 负责人: Timothy E Hewett
• 金额: $ 62.78万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8911250
• 关键词: Accounting; Algorithms; Anatomy; Anterior; Anterior Cruciate Ligament; Biomechanics; Cadaver; Clinical; Computer Simulation; Computers; Data; Elements; Eligibility Determination; Enrollment; Evidence Based Medicine; Failure; Funding; General Population; Grant; Health; Health Care Costs; In Vitro; Incidence; Individual; Injury; Intervention; Kinetics; Knee; Knee Injuries; Knowledge; Laboratories; Lead; Life; Ligaments; Link; Literature; Measures; Mechanics; Medial; Medical; Meta-Analysis; Methodology; Methods; Modeling; Motion; Movement; National Institute of Child Health and Human Development; Pattern; Physiological; Populations at Risk; Prevention program; Preventive; Primary Health Care; Protocols documentation; Public Health; Randomized Controlled Trials; Relative (related person); Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Role; Rotation; Rupture; Sensitivity and Specificity; Series; Specimen; Structure of medial collateral ligament of knee joint; Techniques; Testing; Tissues; Training; Translating; United States; United States National Institutes of Health; Validation; Work; anterior cruciate ligament rupture; base; biomechanical model; clinical application; clinical predictors; clinically relevant; collateral ligament; cost effective; evidence base; high risk; human subject; improved; in vitro testing; in vivo; injury prevention; kinematics; ligament injury; modifiable risk; neuromuscular; novel; parent grant; research study; response; screening; sex; tool

DESCRIPTION (provided by applicant): Anterior cruciate ligament (ACL) injury is a major medical and financial burden. Despite identification of modifiable risk factors and effective preventive measures, global ACL injury incidence remains largely unaffected. Under the parent grant we identified plausible valgus collapse mechanisms for ACL injury without concomitant medial collateral ligament (MCL) injury. A novel cadaveric testing setup we developed under the funded grant has demonstrated a nearly 90% rate of ACL tear. Our findings show that combined knee abduction moment (KAM), anterior tibial shear force (ATS) and internal tibial rotation moment (ITR) generates significantly greater strain in the ACL relative to the MCL, and reproduces kinematics similar to those observed during ACL injury. While these types of loading, in isolation, increase ACL strain and potentially risk of injury, their combined effects o ACL biomechanics are not well understood. In this competing renewal application we will develop a highly impactful and unique ACL injury risk assessment protocol that accounts for multiplanar biomechanics. The protocol will be developed through a novel, integrative in vivo, in vitro and in silico (in sim) approach. The Specific Aims are: I) To develop and validate a multiplanar ACL injury risk assessment algorithm that predicts ACL injury risk based on dynamic ACL strain, and II) To integrate in vivo, in vitro and in silico approaches to establish a 'continuum of risk' that accounts for the relative contributions of KAM, ITR, and ATS to ACL rupture. The critical distinction between the two Aims is the biomechanical context: Aim I will determine how the ACL is strained during non-injurious screening tasks that can be performed in a laboratory or clinical setting. Aim II will establish a direct link between high strain movemet patterns and the ACL injury mechanism(s). We hypothesize that: I) Peak input values of KAM, ITR, and ATS from in vivo data will accurately predict peak ACL strain when landing biomechanics are reproduced in vitro and in silico, and II) Incremental increases in KAM, ITR and ATS, scaled from 'high-risk' in vivo measures will lead to ACL rupture in vitro and in silico. In Specific Aim I, multi-planar kinematics and kinetics will be directly used as inputs to our validated, sex-specific, viscoelastic FE knee models and in vitro test protocols to test our hypotheses. We will also aim to identify and validate simple, clinically-based predictors for KAM, ITR, and ATS to maximize the clinical applicability of the protocol. In Aim II, we will directly examine the roles of KAM, ITR and anterior tibial shear on the likelihood of ACL rupture. High-risk in vivo values for KAM, ATS, and ITR will be incrementally increased until tissue failure is achieved in cadavers, or ACL failure strains are reached in FE models. Furthermore, in Aim II we will optimize our FE modeling approach through validation of a methodology to customize models that accounts for variability in anatomy and tissue mechanics. This research will significantly improve the ability of researchers and clinicians to effectively screen athletes for ACL injury risk, and will increase ACL injury prevention program enrollment and efficacy.

描述（由申请人提供）：前十字韧带 (ACL) 损伤是一项重大的医疗和经济负担。尽管确定了可改变的危险因素并采取了有效的预防措施，但全球 ACL 损伤发生率仍然基本不受影响。在家长资助下，我们确定了 ACL 损伤的合理外翻塌陷机制，而没有伴随内侧副韧带 (MCL) 损伤。我们在资助下开发的新型尸体测试装置已证明 ACL 撕裂率接近 90%。我们的研究结果表明，膝关节外展力矩 (KAM)、胫骨前剪切力 (ATS) 和胫骨内旋转力矩 (ITR) 的组合会在 ACL 中产生比 MCL 更大的应变，并且再现与 ACL 损伤期间观察到的运动学相似的运动学。虽然这些类型的负荷单独来看会增加 ACL 应变和潜在的受伤风险，但它们对 ACL 生物力学的综合影响尚不清楚。在这个竞争性的更新应用中，我们将开发一个具有高度影响力和独特的 ACL 损伤风险评估协议，该协议考虑了多平面生物力学。该协议将通过一种新颖的、综合的体内、体外和计算机（模拟）方法来开发。具体目标是：I) 开发和验证多平面 ACL 损伤风险评估算法，根据动态 ACL 应变预测 ACL 损伤风险，II) 整合体内、体外和计算机方法，建立“风险连续体”，解释 KAM、ITR 和 ATS 对 ACL 断裂的相对贡献。这两个目标之间的关键区别在于生物力学背景：目标 I 将确定在实验室或临床环境中执行的非伤害性筛查任务中 ACL 是如何拉紧的。目标 II 将在高应变运动模式和 ACL 损伤机制之间建立直接联系。我们假设：I) 当在体外和计算机中重现着陆生物力学时，来自体内数据的 KAM、ITR 和 ATS 峰值输入值将准确预测峰值 ACL 应变；II) 根据“高风险”体内测量值缩放的 KAM、ITR 和 ATS 增量将导致体外和计算机中 ACL 断裂。在特定目标 I 中，多平面运动学和动力学将直接用作我们经过验证的、性别特异性、粘弹性有限元膝关节模型和体外测试方案的输入，以测试我们的假设。我们还将致力于识别和验证 KAM、ITR 和 ATS 的简单、基于临床的预测因子，以最大限度地提高该方案的临床适用性。在目标 II 中，我们将直接检查 KAM、ITR 和胫骨前剪切力对 ACL 断裂可能性的作用。 KAM、ATS 和 ITR 的高风险体内值将逐渐增加，直到在尸体中实现组织衰竭，或在 FE 模型中达到 ACL 衰竭应变。此外，在 Aim II 中，我们将通过验证定制模型的方法来优化我们的有限元建模方法，该模型考虑了解剖学和组织力学的可变性。这项研究将显着提高研究人员和临床医生有效筛查运动员 ACL 损伤风险的能力，并将增加 ACL 损伤预防计划的注册人数和有效性。