Effects of Initial ACL Graft Tension on Dynamic Joint Motion and Osteoarthritis Progression

初始 ACL 移植物张力对动态关节运动和骨关节炎进展的影响

• 批准号: 9348581
• 负责人: Jillian Elizabeth Beveridge
• 金额: $ 9.1万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-08 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348581
• 关键词: Acute; Address; Affect; Anatomy; Animal Model; Animals; Anterior; Anterior Cruciate Ligament; Autopsy; Biomechanics; Cartilage; Clinical; Clinical Research; Clinical Trials; Data; Degenerative polyarthritis; Enrollment; Gait; Gold; Image; Imaging Techniques; Impairment; Inferior; Inflammation; Inflammatory; Intervention; Joints; Knee; Knee joint; Ligaments; Light; Limb structure; Longitudinal Studies; Longitudinal cohort; Magnetic Resonance; Magnetic Resonance Imaging; Measures; Mechanics; Mentors; Modeling; Monitor; Morphology; Motion; Operative Surgical Procedures; Outcome; Outcome Measure; Patient Outcomes Assessments; Patient risk; Patients; Phase; Population; Positioning Attribute; Postoperative Period; Procedures; Process; Property; Residual state; Risk; Rotation; Series; Severities; Sheep; Signal Transduction; Structure; Surface; Techniques; Tendon structure; Testing; Time; Tissues; Translations; Work; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; base; bone; cohort; design; experimental study; follow-up; graft function; graft healing; imaging properties; improved; in vivo; injured; insight; joint injury; mechanical properties; patient subsets; prevent; prospective; reconstruction; sample fixation; standard care; tool; translational study

PROJECT SUMMARY/ABSTRACT The objective of the proposed studies is to establish whether the rate and severity of post-traumatic osteoarthritis (PTOA) is related to joint motion abnormalities, and whether inferior in vivo anterior cruciate ligament (ACL) graft biomechanical properties are sufficient to induce joint motion abnormality. The ACL is the most frequently injured knee ligament. Surgical ligament reconstruction using a tendon graft is the gold standard treatment for an ACL tear, but the procedure does not restore normal joint motion completely and fails to prevent PTOA in many subjects. Why ACL reconstruction fails in these two regards is not completely understood. Much information from animal models and ex vivo experiments suggests that ACL graft function is inferior to that of the native ACL. The first mentored phase study will investigate the relationships between abnormal joint motion, long-term joint damage, and impaired graft function following ACL reconstruction in a clinical patient cohort. Accurate 3D knee joint motion during a hopping task will be recorded in a subset of patients and healthy controls enrolled an ongoing prospective clinical trial of ACL reconstruction outcomes (NCT 00434837). Cartilage and bone damage will be quantified from magnetic resonance (MR) images. We will estimate ACL graft stiffness from the MR image properties, and determine whether the abnormal joint motions are related to inferior graft stiffness in this clinical population. Using data from the longitudinal clinical trial will allow us to quantify joint damage progression between earlier time points and the 10-year follow-up, and to understand these structural changes in light of functional joint and ACL graft changes for the first time. However, different 3D anatomical structure and non-anatomical placement of the ACL graft also likely contribute to the residual abnormal joint motions we expect to observe clinically. Therefore, the second independent phase study will utilize an ACL reconstruction animal model and the same MR imaging techniques used in the mentored clinical study to investigate the time course of changes in ACL graft biomechanical properties while using the native ACL as the “graft”. This technique simulates the important aspects of bone drilling and graft fixation in clinical ACL reconstruction, but circumvents the confounding effects of differences in anatomy and function between tendon graft and native ligament. ACL “graft” biomechanical properties and joint motion will be assessed prior to “reconstruction”, and then longitudinally for 20 weeks. The independent phase project will provide insight as to whether a threshold in ligament function exists that preserves joint motion. The translational design of the mentored and independent studies will address why the current gold standard ACL treatment fails to prevent PTOA, provide tools to monitor functional joint and tissue changes non-invasively, and provide targets for new treatment interventions.

项目摘要/摘要 拟议研究的目标是确定创伤后创伤的比率和严重程度 骨性关节炎(PTOA)与关节运动异常有关，且是否亚于活体前路 十字韧带(ACL)移植物的生物力学特性足以诱导关节运动 反常现象。前交叉韧带是最常受伤的膝关节韧带。重建韧带的外科手术 肌腱移植是前交叉韧带撕裂的黄金标准治疗方法，但该方法不能恢复正常关节。 运动完全无效，在许多受试者中未能预防PTOA。这两种情况下ACL重建失败的原因 问候还没有完全理解。来自动物模型和体外实验的大量信息表明 该ACL的移植功能不如本地ACL。第一个指导阶段研究将调查 前交叉韧带术后关节运动异常、长期关节损伤与移植物功能受损的关系 临床患者队列中的重建。在跳跃任务中，将记录准确的3D膝关节运动 在一组登记了正在进行的前交叉韧带重建的前瞻性临床试验的患者和健康对照中 结果(NCT 00434837)。软骨和骨骼的损伤将通过磁共振(MR)进行量化。 图像。我们将根据MR图像的特性来估计前交叉韧带移植物的硬度，并确定是否 在这种临床人群中，关节运动异常与移植物僵硬程度较低有关。使用来自 纵向临床试验将使我们能够量化早期时间点和 10年随访，并根据功能性关节和前交叉韧带移植物的变化了解这些结构变化 这是第一次。然而，不同的三维解剖结构和非解剖位置的前交叉韧带移植物 也可能是我们临床上观察到的残留异常关节运动的原因。因此， 第二个独立阶段的研究将利用前交叉韧带重建动物模型和相同的磁共振成像 用于研究前交叉韧带移植物变化时间进程的指导性临床研究中的技术 生物力学特性，同时使用天然前交叉韧带作为“移植物”。这项技术模拟了重要的 骨钻孔和植骨固定在临床前交叉韧带重建中的应用 肌腱移植与自体韧带解剖和功能差异的影响。前交叉韧带“嫁接” 在“重建”前将评估生物力学特性和关节运动，然后进行纵向重建。 20周。独立阶段的项目将提供关于韧带功能的门槛是否 存在保留关节运动的。指导和独立研究的翻译设计将 解决当前黄金标准前交叉韧带治疗未能预防PTOA的原因，提供工具来监控功能 关节和组织的非侵入性改变，并为新的治疗干预提供靶点。