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（由申请人提供）：随着儿童和青少年人群中有组织体育活动和参与的增加，膝关节前交叉韧带（ACL）损伤急剧增加，发病率与成人相似。选择非手术（保守）或手术治疗部分和完全ACL撕裂仍然是一个争论的话题。然而，重建完全撕裂的ACL越来越受欢迎，以治疗所有年龄段儿童的这些损伤，以恢复膝关节稳定性并允许恢复运动，同时限制其他结构（如内侧半月板）的继发性损伤。与成人情况不同，这些患者的膝关节继续发育，直到骨骼成熟。在儿童期的成长过程中，有限的证据表明，ACL的方向变化相当大，除了增加内在的成熟。然而，很少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超过另一种。事实上，人们对儿童和青少年时期ACL的关节水平功能以及是否存在年龄依赖性变化知之甚少。这些信息对于指导ACL损伤和显著生长剩余的儿童或青少年患者的年龄特异性治疗策略至关重要。本提案的目的是利用替代动物模型来研究ACL及其束在生长关节中的年龄依赖性功能以及部分或完全ACL损伤的影响。该提议的总体假设是猪ACL经历与人类ACL相似的出生后变化，并且这些变化，沿着膝关节几何形状的其他变化以及出生后生长期间组织成熟度的增加导致年龄依赖性1）ACL功能，2）ACL的不同前内侧（AM）和后外侧（PL）束内的负荷分布，和3）ACL损伤对剩余软组织（例如内侧半月板、MCL等）的影响膝关节的损伤为了验证这些假设，我们将利用多学科方法严格评估ACL结构和功能。本提案的第一个目的是使用磁共振成像和空间数字化技术评估猪模型生长期间ACL几何结构的变化，并将这些变化与人体数据进行比较。第二个目标将使用最先进的机器人测试系统在猪模型中评价整个ACL及其AM和PL束对关节功能的年龄依赖性贡献，以研究ACL在多自由度（DOF）中的复杂功能。第三个Aim将确定剩余软组织（例如内侧半月板、MCL等）的负载变化。使用机器人测试系统，在猪模型中，随着年龄的增长，ACL功能部分或完全丧失。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，以及作为开发新置换技术的设计标准。