Imaging post-traumatic osteoarthritis 10-years after ACL reconstruction: a multicenter cohort study with quantitative MRI

ACL 重建 10 年后创伤后骨关节炎的影像学：定量 MRI 的多中心队列研究

• 批准号: 10878519
• 负责人: Xiaojuan Li
• 金额: $ 68.38万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-16 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10878519
• 关键词: 3-Dimensional; Age; Anterior Cruciate Ligament; Area; Arthroscopic Surgical Procedures; Body mass index; Cartilage; Cartilage injury; Clinical; Cohort Studies; Contralateral; Data; Development; Disease; Early Diagnosis; Evaluation Research; Failure; Funding; Future; Gender; Goals; Grant; Image; Infection; Infiltration; Joints; Knee; Lead; Lesion; Longitudinal Studies; Magnetic Resonance Imaging; Maps; Measures; Meniscus structure of joint; Modeling; Monitor; Morphology; Muscle; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Peptide Initiation Factors; Postoperative Period; Prognosis; Publishing; Qualifying; Research Personnel; Resources; Risk Factors; SF-36; Scientist; Shapes; Side; Standardization; Symptoms; Techniques; Testing; Thick; Time; Training; Traumatic Arthropathy; United States National Institutes of Health; Width; anterior cruciate ligament injury; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; articular cartilage; bone; cartilage degradation; clinical imaging; cohort; design; follow-up; graft failure; high risk; improved; instrument; joint destruction; knee replacement arthroplasty; meniscal tear; meniscus injury; modifiable risk; novel; prevent; prospective; quantitative imaging; randomized, clinical trials; reconstruction; soft tissue

PROJECT SUMMARY/ABSTRACT Anterior Cruciate Ligament (ACL) injury is a proven high-risk factor for post-traumatic osteoarthritis (PTOA) development despite ACL reconstruction (ACLR). However, our understanding of PTOA development after ACLR is limited, and reliable “markers” (risk factors) that provide early diagnosis and prognosis are still lacking. Long-term studies of PTOA after ACLR primarily used radiographs for evaluating structural damage, which only provided information limited to bone changes that occur at late stages of the disease. Previous MRI studies after ACLR are primarily limited to short/mid-term follow up. The long-term degeneration of soft tissue, their relationship to each other, and to patient symptoms and outcomes after ACLR are largely unknown. In this study, we aim to fill this gap and propose to add morphologic and quantitative MRI (qMRI) to the novel nested cohort from the Multicenter Orthopaedic Outcomes Network (MOON) at 10 years after ACLR. The NIH funded MOON study was designed to follow ACLR patients after surgery to determine their clinical outcomes including risk factors for the initiation and progression of PTOA. The MOON cohort is unique in the world with >3500 participants and greater than 80% follow-up at 2, 6, and 10 years. The MOON group has published extensively on multivariable modeling on risk factors for patient reported outcomes measures (PROMs), and infrequent outcomes (graft failure, infection, total knee arthroplasty). Further, a novel nested cohort (n=425) was initiated within the MOON cohort which consists of young active patients with a comprehensive research evaluation including radiographs, physical and instrumented laxity examination, and functional testing. In this study, we will add state-of-the-art qMRI to this nested cohort to evaluate cartilage (thickness and matrix composition T1r and T2), bone (3D shape modeling), muscle (volume and fatty infiltration), and other OA-related lesions. The overarching goal of the study is to characterize long-term structural damage and articular cartilage degeneration after ACLR, understand their patterns and relationship to patient outcomes, and identify modifiable predictors for PTOA at 10 years after ACLR from pre-operative and early postoperative time points. Furthermore, the MRI measures, such as cartilage T1r and T2, at 10 years will also serve as potential predictors for future PTOA development (for those who do not develop PTOA at 10 years), failure of the ACLR graft or contralateral ACL, and additional arthroscopic surgery at the 20 years post-ACLR MOON time point. The proposed study will leverage resources from the NIH funded MOON grant, and this is a unique, first ever, opportunity to comprehensively evaluate the knee structural damage and their interrelationship with patient outcomes at 10 years after ACLR in a prospective, well characterized and closely monitored cohort. By identifying modifiable predictors of structural damage at 10 years after ACLR from baseline and early postoperative time points, this study can have immediate impact on improving patient management and treatment, as well as lead to further RCT on identified modifiable risk factors to reduce and prevent PTOA following ACLR.

项目概要/摘要 前十字韧带 (ACL) 损伤已被证明是创伤后骨关节炎的高危因素 尽管 ACL 重建 (ACLR)，但 (PTOA) 仍在发展。然而，我们对PTOA发展的理解 ACLR 受到限制后，提供早期诊断和预后的可靠“标志物”（危险因素）仍然存在 缺乏。 ACLR 后 PTOA 的长期研究主要使用射线照片来评估结构损伤， 其仅提供仅限于疾病晚期发生的骨骼变化的信息。以前的核磁共振检查 ACLR 后的研究主要限于短期/中期随访。软组织长期退化， 它们之间的关系以及与 ACLR 后患者症状和结果的关系在很大程度上尚不清楚。 在这项研究中，我们的目标是填补这一空白，并建议在新颖的研究中添加形态学和定量 MRI (qMRI) ACLR 术后 10 年来自多中心骨科结果网络 (MOON) 的嵌套队列。美国国立卫生研究院 资助的 MOON 研究旨在跟踪 ACLR 患者手术后以确定他们的临床结果 包括 PTOA 发生和进展的危险因素。 MOON 队列在世界上是独一无二的 >3500 名参与者，2 年、6 年和 10 年随访率超过 80%。 MOON小组已发表 广泛研究患者报告结果测量（PROM）风险因素的多变量模型，以及 罕见的结果（移植失败、感染、全膝关节置换术）。此外，一个新的嵌套队列（n = 425）是 在 MOON 队列中发起，该队列由年轻活跃的患者组成，进行了全面的研究 评估包括射线照相、物理和仪器松弛检查以及功能测试。在这个 研究中，我们将在这个嵌套队列中添加最先进的 qMRI 来评估软骨（厚度和基质 成分 T1r 和 T2）、骨骼（3D 形状建模）、肌肉（体积和脂肪浸润）以及其他 OA 相关 病变。该研究的总体目标是表征长期结构损伤和关节软骨 ACLR 后的退化，了解其模式以及与患者结果的关系，并确定可修改的方法 ACLR 术后 10 年的术前和术后早期时间点的 PTOA 预测因子。此外， 10 年后的 MRI 测量（例如软骨 T1r 和 T2）也将作为未来的潜在预测因素 PTOA 发生（对于 10 年后未发生 PTOA 的患者）、ACLR 移植物或对侧失败 ACL 以及在 ACLR MOON 时间点后 20 年进行的额外关节镜手术。 拟议的研究将利用 NIH 资助的 MOON 赠款的资源，这是一项独特的、首次的研究 有史以来，有机会全面评估膝关节结构损伤及其与患者的相互关系 在一个前瞻性、特征明确且密切监测的队列中，ACLR 后 10 年的结果。通过识别 ACLR 术后 10 年结构损伤的可修改预测因素（从基线和术后早期开始） 要点，这项研究可以对改善患者管理和治疗产生立竿见影的影响，并引导 进一步对已确定的可改变风险因素进行随机对照试验，以减少和预防 ACLR 后的 PTOA。