Understanding the Mechanical Underpinnings of Rotator Cuff Tear and Surgical Repair

了解肩袖撕裂和手术修复的机械基础

• 批准号: 10536970
• 负责人: Morgan Dalman
• 金额: $ 3.87万
• 依托单位: NORTH CAROLINA STATE UNIVERSITY RALEIGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10536970
• 关键词: 3-Dimensional; Activities of Daily Living; Acute; Affect; Age; American; Anatomy; Area; Articular Range of Motion; Atrophic; Caring; Characteristics; Clinical; Contralateral; Custom; Data; Development; Fatty acid glycerol esters; Fiber; Financial cost; Future; Generations; Image; Impairment; Individual; Infiltration; Injury; Intramuscular; Joints; Lead; Length; Limb structure; Linear Regressions; Location; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Medical Imaging; Methods; Modeling; Monte Carlo Method; Muscle; Muscle function; Muscular Atrophy; Musculoskeletal; Operative Surgical Procedures; Outcome; Pain; Pain-Free; Patients; Performance; Physiological; Play; Postoperative Period; Prevalence; Probability; Production; Quality of life; Research; Risk; Rotator Cuff; Rupture; Scanning; Series; Shoulder; Stretching; Surgeon; Tendon structure; Tissues; age related; base; clinically relevant; common treatment; computer framework; economic cost; experience; follow-up; functional outcomes; improved; in vivo; injured; injury and repair; predictive modeling; pressure; repaired; rotator cuff injury; rotator cuff tear; severe injury; simulation; success; supraspinatus muscle; surgery outcome; tool

Project Summary Rotator cuff injuries affect 4.5 million Americans and the increase in prevalence of rotator cuff injuries correlates with increasing age. Around 250,000 rotator cuff repairs are performed each year, equating to over three billion dollars in economic cost. The rotator cuff is critically important in activities of daily living, and therefore damage to the rotator cuff can limit independence and quality of life. Rotator cuff tears are commonly treated with surgical reattachment of the tendon; however, surgery is not always advisable due to the high probability of retear. High repair tension during reattachment surgery is not only technically challenging during repair but also is often followed by post-surgical retear, limited functional capacity, and/or shoulder instability due to altered joint contact forces. Thus, a method to predict repair tension could play a key role in surgical selection. Repair tension is intraoperatively measured; therefore, it cannot inform the decision to operate. Surgeons currently must select patients for surgical repair based on other MR imaging parameters associated with poor outcomes and more severe injury. Following injury of the rotator cuff, the muscle-tendon unit undergoes physiological changes including retraction, muscle atrophy, and increased intramuscular fat and fibrous tissue. However, it is unclear whether there is a direct relationship between repair tension and the three main clinical parameters typically used for determining surgical candidacy (intramuscular fat, muscle atrophy, and retraction). Given the financial costs associated with surgical intervention and the physical burden experienced by patients, an improved understanding of the factors that influence rotator cuff injury and repair tension are needed to provide a higher level of care for surgery patients, thus positively impacting the quality of life for millions of Americans. Our overall objective is to understand the mechanical underpinnings of rotator cuff repair to identify relationships between physiological changes and post-surgical outcomes. This research will provide crucial information needed to inform likelihood of surgical success and better predict surgical outcomes, thereby guiding development of a standard of practice for rotator cuff repair surgery. The proposed research combines an experimental and computational framework to (1) determine the relationship between rotator cuff injury-induced physiological changes and repair tension, and (2) determine how physiological changes due to rotator cuff injury and elevated repair tension influences post-surgical outcomes.

项目概要 肩袖损伤影响着 450 万美国人，肩袖损伤患病率的增加与此相关 随着年龄的增长。每年进行约 250,000 次肩袖修复，相当于超过 30 亿次 美元的经济成本。肩袖在日常生活活动中至关重要，因此会造成损伤 肩袖的过度运动会限制独立性和生活质量。肩袖撕裂通常通过手术治疗 肌腱重新附着；然而，由于复发的可能性很高，并不总是建议进行手术。高的 复位手术期间的修复张力不仅在修复过程中具有技术挑战性，而且通常 其次是术后后退、功能能力有限和/或由于关节接触改变而导致肩部不稳定 力量。因此，预测修复张力的方法可以在手术选择中发挥关键作用。修复张力为 术中测量；因此，它无法告知运营决定。外科医生目前必须选择 根据与不良结果等相关的其他 MR 成像参数进行手术修复的患者 重伤。肩袖受伤后，肌肉肌腱单位会发生生理变化 包括回缩、肌肉萎缩以及肌内脂肪和纤维组织增加。然而尚不清楚 修复张力与三个主要临床参数之间是否存在直接关系 用于确定手术候选资格（肌内脂肪、肌肉萎缩和回缩）。鉴于财务 与手术干预相关的费用以及患者所经历的身体负担，改善了 需要了解影响肩袖损伤和修复张力的因素，以提供更高的 手术患者的护理水平，从而对数百万美国人的生活质量产生积极影响。我们的整体 目标是了解肩袖修复的机械基础，以确定之间的关系 生理变化和术后结果。这项研究将提供所需的重要信息 告知手术成功的可能性并更好地预测手术结果，从而指导开发 肩袖修复手术的实践标准。拟议的研究结合了实验和 计算框架（1）确定肩袖损伤引起的生理学之间的关系 变化和修复张力，以及（2）确定由于肩袖损伤和升高引起的生理变化如何 修复张力影响术后结果。