Age-Dependent ACL Function During Growth: Guiding Injury Treatment in Children

生长过程中年龄依赖性 ACL 功能：指导儿童损伤治疗

• 批准号: 8895469
• 负责人: Matthew B Fisher
• 金额: $ 7.58万
• 依托单位: NORTH CAROLINA STATE UNIVERSITY RALEIGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8895469
• 关键词: Adolescence; Adolescent; Adult; Age; Algorithms; Animal Model; Animals; Anterior; Anterior Cruciate Ligament; Appearance; Area; Biochemical; Biomechanics; Birth; Child; Childhood; Childhood Injury; Clinical; Complex; Data; Devices; Exercise; Family suidae; Freedom; Geometry; Goals; Growth; Human; Image; Incidence; Individual; Injury; Investigation; Joints; Knee; Knee joint; Knowledge; Magnetic Resonance Imaging; Materials Testing; Measures; Mechanics; Medial meniscus structure; Modeling; Operative Surgical Procedures; Orthopedic Surgery procedures; Orthopedics; Patients; Population; Property; Relative (related person); Robotics; Role; Sports; Structure; System; Techniques; Technology; Testing; Tissues; Training Programs; Work; adolescent patient; age related; anterior cruciate ligament rupture; arm; base; design; human data; injured; injury prevention; joint function; ligament injury; notch protein; pediatric patients; postnatal; programs; public health relevance; reconstruction; skeletal; soft tissue; tibia; treatment strategy

 DESCRIPTION (provided by applicant): With increasing activity and participation in organized sports within the pediatric and adolescent populations, injuries to the anterior cruciate ligament (ACL) of the knee joint are rising dramatically, with similar incidence levels as adults. The choic of non-surgical (conservative) or surgical treatment of both partial and complete ACL tears remains a subject of debate. However, reconstruction of a completely torn ACL is becoming increasingly popular to treat these injuries in children of all ages in order to restore knee stabiity and permit the return to sports while limiting secondary injuries to other structures, such as the medial meniscus. Unlike the adult scenario, the knee joint continues to evolve in these patients until skeletal maturity. During childhood growth, limited evidence suggests the orientation of the ACL changes considerably in addition to increased intrinsic maturation. Yet, little biomechanical data exists to support the use of surgical or non-surgical treatment or the use of one reconstruction technique over another. In fact, there is little knowledge about the joint-level function of the ACL during childhood and adolescence and whether age-dependent changes exist. Such information would be critical to guide age-specific treatment strategies for pediatric or adolescent patients with ACL injuries and significant growth remaining. The goal of this proposal is to utilize a surrogate animal model to study the age-dependent function of the ACL and its bundles in the growing joint as well as the impact of partial or complete ACL injury. The overall hypotheses of this proposal are that the porcine ACL undergoes similar postnatal changes as the human ACL, and that these changes, along with other changes in knee joint geometry and increasing tissue maturity during postnatal growth result in age-dependent 1) ACL function, 2) load distribution within the distinct anteromedial (AM) and posterolateral (PL) bundles of the ACL, and 3) impact of an ACL injury on the remaining soft tissues (e.g. medial meniscus, MCL, etc.) of the knee joint. To test these hypotheses, we will utilize a multi-disciplinary approach to rigorously assess ACL structure and function. The first Aim of this proposal will assess changes in ACL geometry during growth in the porcine model using magnetic resonance imaging and spatial digitizing technologies and compare these changes to human data. The second Aim will evaluate the age-dependent contribution of the entire ACL as well as its AM and PL bundles to joint function in the porcine model using a state-of-the-art robotic testing system to study the complex function of the ACL in multiple degrees-of-freedom (DOF). The third Aim will determine the changes in loading of the remaining soft tissues (e.g. medial meniscus, MCL, etc.) in the porcine model with the loss of partial or complete ACL function with respect to age using the robotic testing system. Upon the successful completion of these aims, the knowledge obtained can be extended to guide surgical and/or non-operative treatment or inform exercise programs for injury prevention as well as to serve as design criteria for developing new replacement techniques.

 描述(申请人提供)：随着儿童和青少年群体中越来越多的活动和参与有组织的运动，膝关节前十字韧带(ACL)的损伤急剧增加，发病率与成人相似。选择非手术(保守)或手术治疗部分和全部前交叉韧带撕裂仍然是一个有争议的话题。然而，重建完全撕裂的前交叉韧带越来越多地用于治疗各个年龄段的儿童的这些损伤，以恢复膝关节的稳定性并允许恢复运动，同时将继发性损伤限制在其他结构，如内侧半月板。与成人的情况不同，这些患者的膝关节会继续进化，直到骨骼成熟。在儿童的成长过程中，有限的证据表明，除了增加内在成熟度外，前交叉韧带的取向也发生了很大的变化。然而，几乎没有生物力学数据支持使用手术或非手术治疗或使用一种重建技术而不是另一种重建技术。事实上，关于前交叉韧带在儿童和青春期的联合水平功能以及是否存在年龄相关性变化的知识很少。这些信息将对指导儿童或青少年前交叉韧带损伤并仍有显着增长的患者的特定年龄治疗策略至关重要。该方案的目的是利用代理动物模型研究前交叉韧带及其束在生长关节中的年龄依赖性功能，以及部分或全部前交叉韧带损伤的影响。这项建议的总体假设是，猪前交叉韧带在出生后经历与人类前交叉韧带相似的变化，这些变化，以及出生后生长过程中膝关节几何形状的其他变化和组织成熟度的增加，导致1)年龄相关的前交叉韧带功能，2)前内侧(AM)和后外侧(PL)束中不同的负荷分配，以及3)前内侧半月板(AM)和后外侧(PL)束内的负荷分布，以及前交叉韧带损伤对剩余软组织(如内侧半月板，MCL等)的影响。在膝盖的关节上。为了验证这些假设，我们将利用多学科方法严格评估前交叉韧带的结构和功能。这项建议的第一个目标是使用磁共振成像和空间数字化技术评估猪模型生长过程中前交叉韧带几何形状的变化，并将这些变化与人类数据进行比较。第二个目标将使用最先进的机器人测试系统来评估整个前交叉韧带及其AM和PL束对猪模型关节功能的年龄相关性贡献，以研究前交叉韧带在多个自由度(DOF)中的复杂功能。第三个目标将确定剩余软组织(如内侧半月板、MCL等)的负荷变化。在猪模型中，使用机器人测试系统，根据年龄部分或完全丧失前交叉韧带功能。在成功完成这些目标后，所获得的知识可以扩展到指导手术和/或非手术治疗，或为预防损伤的锻炼计划提供信息，以及作为开发新的替代技术的设计标准。