Improving the Detection, Classification and Treatment of Misaligned Arthritic Ankles

踝关节骨关节炎（OA）是一种使人衰弱和活动受限的疾病。它通常可以源于 创伤性损伤的结果-这种创伤在服兵役中很普遍。如果软骨不是 在创伤中严重受损的情况下，关节的稳定性和对齐可能会受到影响。随着时间的推移，一个不稳定或 由于异常运动学，未对准的踝关节可能经历异常的软骨磨损率。 虽然OA可能需要几十年的发展，从这种创伤所产生的关节炎状态将最终需要 踝关节置换或融合，后果是巨大的经济负担和生活质量的影响。 关于对准，特别是在冠状平面中，当前的临床诊断依赖于静态X-线检查。 踝关节的射线。静态图像可能无法指示步态期间的动态未对准。此外， 楔形鞋垫，一个潜在的保守治疗，对踝关节功能的恢复是无证的。 该提案旨在使用双平面荧光透视（一种基于X射线的动态成像方法）来测量 OA受试者（踝关节内翻、中立和外翻对线）和对照组的踝关节运动学。与此 方法，可以测量步态期间的胫距运动学。此外，被归类为中性的受试者 他们的静态X线片，但在步态中显示踝关节内翻或外翻对齐，将被识别。 提高诊断结果的准确性为患者组提供了额外的途径， 治疗我们将研究我们的3D运动学和临床2D成像之间的相关性， 临床诊断学。我们还将能够测量楔形鞋垫对踝关节恢复的影响 功能考虑到这一点，提出了以下目标和方法。 具体目标1：研究对照组和OA受试者的踝关节运动学。在 为了支持特定目标1，将招募90名踝关节OA受试者（内翻、中立或外翻对齐各30名 脚踝）。我们还将招募20名对照受试者。受试者将接受足部CT扫描，以量化骨骼 几何结构（双平面透视所需的步骤）。然后，受试者将在双平面系统中成像， 步态试验和穿着中性学习鞋。这将产生这些患者步态期间的胫骨-距骨运动学， 人口数量。具体目标2：识别OA受试者的动态踝关节错位， 目前使用静态分析被分类为中性对齐。我们将比较静态X射线和 OA受试者的步态运动学，特别是临床确定的中性对线的受试者。我们将 确定中立OA受试者在步态期间实际表现出错位的比例， 分类不当。我们还将从我们的3D数据中重新创建2D临床X射线视图， 将我们的改进（使用3D透视）转化为更准确地将对线分类为临床2D 诊断具体目标3：评价外侧或内侧楔入修复的可能性 踝关节骨性关节炎患者的对线。OA受试者将穿着楔形鞋进行成像 鞋垫对应于它们的错位类型。中性OA受试者，显示未对准 在步态期间，将被召回用于楔形鞋垫会话。这产生保守的治疗运动学。 本研究将生成描述对照组和踝关节OA受试者运动学的基线数据。这 数据目前在文献中不可用，并且代表了对该领域的新贡献。二是这个 该提案确定了当前2D X射线方法在检测动态未对准方面的准确性。这 信息可以告知临床医生他们的诊断工具的准确性，并可能导致改进。 第三，这项建议将产生数据，以评估实用的楔形鞋垫的保守 管理踝关节错位。总之，本研究对诊断具有直接影响潜力 治疗踝关节OA。最后，还有许多其他的分类、诊断和 预防性研究，为退伍军人的利益，这将源于这个职业发展奖。

Ankle osteoarthritis (OA) is a debilitating and mobility limiting condition. It can commonly stem from the result of a traumatic injury – such trauma has a high prevalence in military service. If cartilage is not severely damaged in that trauma, the stability and alignment of the joint may be. Over time, an unstable or misaligned ankle joint can experience abnormal rates of cartilage wear and tear due to aberrant kinematics. While OA may take decades to develop, the resulting arthritic state from this trauma will ultimately require ankle replacement or fusion, consequences with a tremendous financial burden and quality of life impact. With regards to alignment, particularly in the coronal plane, current clinical diagnosis relies on static X- ray of the ankle joint. Static images may not indicate dynamic misalignment during gait. Further, the effect of wedged insoles, a potential conservative treatment, on the restoration of ankle function is undocumented. This proposal aims to use biplane fluoroscopy, an X-ray based dynamic imaging approach, to measure ankle kinematics in OA subjects (with varus, neutral and valgus ankle alignment) and controls. With this method, tibio-talar kinematics during gait can be measured. Furthermore, subjects classified as neutral from their static radiograph, but that exhibit ankle varus or valgus alignment during gait, will be identified. Improving the accuracy of a diagnostic outcome provides a patient group with additional avenues for treatment. We will investigate correlations between our 3D kinematics and clinical 2D imaging – to the benefit of clinical diagnostics. We will also be able to measure the effect of wedged insoles on the restoration of ankle function. With this in mind, the following aims and methodology are proposed. Specific Aim 1: To investigate ankle kinematics in controls and subjects with OA. In support of Specific Aim 1, 90 ankle OA subjects will be recruited (30 each of varus, neutral or valgus aligned ankles). We will also recruit 20 control subjects. Subjects will receive CT scans of their feet to quantify bone geometry (a step necessary for biplane fluoroscopy). Subjects will then be imaged in the biplane system during gait trials and while wearing neutral study shoes. This will yield tibio-talar kinematics during gait for these populations. Specific Aim 2: To identify dynamically misaligned ankles in OA subjects who are currently classified as neutrally aligned using static analysis. We will compare the static X-ray and the gait kinematics of OA subjects, particularly those with clinically determined neutral alignment. We will determine what proportion of neutral OA subjects actually exhibit misalignment during gait and are thus improperly categorized. We will also re-create 2D clinical X-ray views from our 3D data in an attempt to translate our improvement (with 3D fluoroscopy) to more accurately classify alignment to clinical 2D diagnostics. Specific Aim 3: To evaluate the potential of lateral or medial wedging to restore alignment in misaligned ankle OA subjects. OA subjects will be imaged wearing shoes with wedged insoles which correspond to their type of misalignment. Neutral OA subjects, who demonstrate misalignment during gait, will be recalled for a wedged insole session. This yields conservative treatment kinematics. This study will generate baseline data describing the kinematics of control and ankle OA subjects. This data is not currently available in the literature, and represents a novel contribution to the field. Second, this proposal determines how accurate current 2D X-ray methods are at detecting dynamic misalignment. This information can inform clinicians about the accuracy of their diagnostic tools, and may lead to improvements. Third, this proposal will generate data to evaluate the utility of wedged insoles for the conservative management of ankle misalignment. In Summary, this study has immediate impact potential on the diagnosis and treatment of ankle OA. Last, there are numerous additional avenues of classification, diagnostic, and preventative research for the benefit of the veterans which will stem from this Career Development Award.