Walk this Way: Physical Activity and Walking Biomechanics Lead to Early Knee OA Symptoms and Ultrasound-Detected Structural Pathology after ACL Reconstruction

以此方式行走：体力活动和行走生物力学导致 ACL 重建后早期膝关节 OA 症状和超声检测的结构病理学

• 批准号: 10670394
• 负责人: Matthew Harkey
• 金额: $ 12.72万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670394
• 关键词: Accelerometer; Atlases; Biomechanics; Bone Spur; Cartilage; Classification; Clinical; Clinical Trials; Clinical Trials Design; Collaborations; Data Analyses; Degenerative polyarthritis; Development; Devices; Diagnosis; Event; Evidence based intervention; Future; Grant; Injury; Joints; Knee; Knee Injuries; Knee Osteoarthritis; Laboratories; Lead; Level of Evidence; Life; Life Experience; Meniscus structure of joint; Mentors; Monitor; Motion; Operative Surgical Procedures; Outcome; Pain; Participant; Pathology; Patients; Persons; Physical activity; Popliteal Cyst; Population; Predisposition; Quality of life; Reaction; Reconstructive Surgical Procedures; Reporting; Research; Risk; Risk Factors; Sports Medicine; Standardization; Symptoms; Synovitis; System; Time; Training; Ultrasonography; United States; Visit; Walking; Work; adduct; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; biomechanical test; chronic pain; clinical trial participant; disability; effusion; evidence base; gait rehabilitation; high risk; improved; insight; joint loading; modifiable risk; novel; persistent symptom; prevent; radiological imaging; recruit; risk mitigation; skills; trial planning; ultrasound; young adult

PROJECT SUMMARY About 250,000 anterior cruciate ligament (ACL) injuries occur annually in the United States and are primarily treated with a surgical reconstruction (ACLR). However, for at least 1 in 3 young adults with an ACLR, the injury and surgery are pivotal life events that lead to chronic pain, diminished long-term quality of life, and an increased risk for osteoarthritis (OA). The 1st year post-ACLR is critical to a patient’s long-term outcomes as there is evidence that levels of pain and quality of life experienced at 1 year post-ACLR will remain unchanged for up to 10 years. Additionally, at 1 year post-ACLR, ~33% of young adults present with knee structural pathologies. Unfortunately, there are no evidence-based strategies to identify people during the 1st year post-ACLR who are at risk for chronic symptoms or structural pathology. Hence, we cannot identify susceptible populations and lack critical insights into which modifiable risk factors could decrease their risk and prevent lifelong disability. Potentially modifiable risk factors that are common throughout the 1st year post-ACLR are alterations in walking biomechanics and insufficient levels of physical activity. Since poor symptoms and pre-radiographic structural pathology are risk factors for the development of knee OA, understanding modifiable risk factors that relate to poor symptomatic and structural outcomes during the 1st year post-ACLR is needed for future studies to identify therapies that prevent OA. The objective of this study is to determine how longitudinal changes in PA and walking biomechanics assessed at 3, 6, 9, and 12 months post-ACLR relate to poor symptomatic or structural outcomes during the 1st year post-ACLR. This will be the first study that applies the following outcomes to young adults at multiple visits during the 1st year post-ACLR: 1) classification criteria for early OA symptoms, 2) clinically accessible whole-knee ultrasound scoring system to detect multiple structural pathologies. PA will be assessed with research-grade accelerometers to quantify steps per day and weekly minutes of moderate to vigorous PA during a 7-day period following each study visit. Walking biomechanics will be assessed in a motion capture laboratory to quantify vertical ground reaction force and internal knee adduction moment. My central hypothesis is that participants with a moderate change in PA and walking biomechanics post-ACLR will be less likely to have poor symptomatic and structural outcomes during the 1st year when compared to people with a rapid increase or no change in PA and walking biomechanics. The expected outcome of this work is to identify: 1) at- risk patients post-ACLR who are the ideal participants for clinical trials aimed at preventing poor symptomatic and structural outcomes, and 2) when PA or walking biomechanics need to be targeted during the 1st year post- ACLR. This proposal will also provide the PI with the training and mentoring to develop a novel skill set in whole- knee ultrasound imaging, device-based PA monitoring, longitudinal data analyses, and clinical trial design. This training and mentoring will directly lead to an R34 clinical trial planning grant to develop a clinical trial using gait retraining or PA promotion to prevent poor symptomatic or structural outcomes in high-risk patients post-ACLR.

项目摘要 大约25万个前交叉韧带（ACL）损伤每年在美国发生，是主要的 用手术重建（ACLR）治疗。但是，至少有3名年轻人患有ACLR的年轻人，伤害 手术是导致慢性疼痛，长期生活质量降低以及增加的关键生活事件 骨关节炎（OA）的风险。 ACLR后第一年对于患者的长期结局至关重要，因为 证据表明，ACLR 1年后经历的痛苦和生活质量水平将保持不变 10年。此外，在ACLR后1年，约有33％的年轻人患有膝盖结构病理。 不幸的是，在ACLR的第一年中，没有循证策略可以识别人 有慢性症状或结构病理的风险。因此，我们无法确定易感人群，并且缺乏 批判性洞察力可修改风险因素可以降低其风险并防止终身残疾。 在ACLR后整个第一年中常见的潜在可修改风险因素是行走的改变 生物力学和体育锻炼水平不足。由于症状不良和射照前结构 病理是膝盖OA发展的危险因素，了解与 在以后的研究中，需要在ACLR之后的第1年期间症状和结构性不佳才能识别 预防OA的疗法。这项研究的目的是确定PA和行走的纵向变化 与症状或结构性结果相关的ACLR后3、6、9和12个月评估的生物力学 在ACLR之后的第一年。这将是第一个将以下结果适用于年轻人的研究 ACLR后第一年的多次访问：1）早期OA符号的分类标准，2）临床上 可访问的全膝关节超声评分系统，以检测多种结构病理。 PA将评估 使用研究级加速度计，可以量化每天的步骤和每周的现代时间到剧烈的PA 在每次研究之后的7天期间。步行生物力学将在运动捕获中评估 实验室以量化垂直地面反应力和内部膝盖添加力矩。我的中心假设 是在ACLR之后具有现代变化和步行生物力学的现代变化的参与者不太可能 与迅速的人相比，在第一年的症状和结构性结果差 PA和行走生物力学的增加或没有变化。这项工作的预期结果是确定：1​​） ACLR的风险患者是临床试验的理想参与者，旨在防止症状不良 和结构性结果，以及2）当PA或步行生物力学在一年后的第1年中需要针对 ACLR。该建议还将为PI提供培训和心理，以开发整个新颖的技能 - 膝盖超声成像，基于设备的PA监测，纵向数据分析和临床试验设计。这 培训和心理直接将直接导致R34临床试验计划赠款，以使用步态制定临床试验 促进或促进PA以防止ACLR高危患者的症状或结构性不良。