How Partial Meniscectomy Affects Contact Mechanics and Tissue Response

部分半月板切除术如何影响接触力学和组织反应

• 批准号: 10614167
• 负责人: Suzanne A. Maher
• 金额: $ 4.66万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-12 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10614167
• 关键词: Activities of Daily Living; Affect; Articular Range of Motion; Biomechanics; Body mass index; Bone structure; Bypass; Cadaver; Cartilage; Characteristics; Classification; Clinical; Clinical Research; Communities; Computer Models; Counseling; Data; Degenerative polyarthritis; Development; Disease; Elements; Exhibits; Gait; Geometry; Goals; Health; Heterogeneity; In Vitro; Injury; Joints; Knee; Knee Osteoarthritis; Knee joint; Lateral; Location; Magnetic Resonance Imaging; Mechanics; Medial; Meniscus structure of joint; Methodology; Modeling; Operative Surgical Procedures; Outcome; Patients; Pharmacology; Positioning Attribute; Postoperative Period; Predictive Factor; Predisposition; Prevalence; Procedures; Property; Publishing; Radiology Specialty; Rehabilitation therapy; Risk; Risk Factors; Role; Site; Stress; Structure; Surgeon; Techniques; Testing; Time; Tissues; Uncertainty; articular cartilage; base; bone; cohort; follow-up; functional restoration; high risk; human model; in silico; in vivo; joint destruction; kinematics; knee mechanics; musculoskeletal injury; pain relief; patient population; patient subsets; prospective; repaired; response; screening

Functioning menisci are critical to knee joint health. If a damaged meniscus cannot be repaired, a section is removed in a “partial meniscectomy” (PM) procedure. While PM can relieve pain and restore function, the long- term result is an increased predisposition to osteoarthritis (OA), the development of which is often clinically silent in the early years. The prevalence of joint degeneration subsequent to meniscal surgery is highly variable across patients, with up to 40% of patients manifesting radiological evidence of the disease at 5 years post- operatively. Despite a vast number of clinical studies, the risk factors associated with developing OA after PM are essentially unknown. With such varied responses, it is impossible to counsel patients on expected outcome after meniscal surgery. Given the fundamental role of the meniscus in distributing forces across the knee joint, changes in knee mechanics that occur with PM have been implicated. The goal of this study is to determine which knee-specific mechanical factors are predictors for the development of post-PM OA. Our primary hypothesis is that the changes in the distribution of knee joint forces (e.g., contact stresses) after PM will constitute a key risk factor for articular cartilage and meniscal degeneration, independent of compartment. We will test this hypothesis by determining which mechanical factors adversely change the distribution of knee joint forces (in vitro studies) and which are strong predictors for the development of post- PM OA (in vivo studies). We will use: (a) a statistically driven experimentally validated computational approach to identify geometric features, tissue properties, and kinematic characteristics that influence contact force distribution across intact and PM knees, and (b) a mechanobiological analysis of a cohort of patients from pre- to post- PM surgery. By using a broad array of synergistic models (cadaveric, computational, patient-based, and statistical), our study will determine which “clinically identifiable” mechanical features are responsible for significant changes in contact mechanics for post-PM knees. Our experimentally validated computational models will be shared with clinicians and the wider scientific community for the classification of patients at “high risk” for post-PM OA in whom modified surgical, pharmacological, and/or rehabilitation techniques could help to mitigate these risk factors.

功能性膝关节炎对膝关节健康至关重要。如果受损的半月板无法修复， 在“部分阑尾切除术”（PM）中移除。虽然PM可以缓解疼痛和恢复功能，但长期- 长期结果是骨关节炎（OA）的易感性增加，其发展通常在临床上是 早年沉默。腰椎手术后关节退行性变的患病率是高度可变的 在患者中，高达40%的患者在术后5年表现出疾病的放射学证据， 有效地尽管有大量的临床研究，与PM后发生OA相关的风险因素 基本上是未知的。由于反应如此多样，无法就预期结果向患者提供咨询 手术后，考虑到半月板在膝关节上分布力的基本作用， 与PM有关的膝关节力学变化也有牵连。本研究的目的是确定 哪些膝关节特异性机械因素是PM后OA发展的预测因子。我们的首要 假设是膝关节力分布的变化（例如，接触应力） 将构成关节软骨和关节退行性变的关键风险因素， 车厢我们将通过确定哪些机械因素不利地改变 膝关节力的分布（体外研究），并且是术后 PM OA（体内研究）。我们将使用：用途：（a）统计驱动、实验验证的计算方法 识别影响贴靠力的几何特征、组织特性和运动学特征 在完整和PM膝关节上的分布，以及（B）对来自术前的患者队列的机械生物学分析。 到PM手术后。通过使用广泛的协同模型（尸体模型、计算模型、基于患者的模型、 和统计学），我们的研究将确定哪些“临床可识别”的机械特征负责 PM后膝关节接触力学的显著变化。我们的实验验证计算 模型将与临床医生和更广泛的科学界共享，用于对“高”患者进行分类。 改良的手术、药理学和/或康复技术可能有助于缓解PM后OA的“风险”， 降低这些风险因素。