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: 10615019
• 负责人: Suzanne A. Maher
• 金额: $ 36.71万
• 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 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10615019
• 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; 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; 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; pharmacologic; predictive modeling; prospective; repaired; response; risk mitigation; 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.

功能正常的半月板对膝关节健康至关重要。如果损伤的半月板不能修复，就会有一段 在“部分半月板切除”(PM)程序中被移除。虽然PM可以缓解疼痛和恢复功能，但长期- 长期的结果是骨关节炎(OA)的易感性增加，这种疾病的发展通常是临床上的 早年默默无闻。半月板手术后关节退行性变的发生率是高度可变的。 在所有患者中，高达40%的患者在5年后表现出疾病的放射学证据- 从操作上讲。尽管有大量的临床研究，但PM后发生骨性关节炎的风险因素 基本上是未知的。由于反应如此不同，不可能对患者的预期结果进行咨询。 半月板手术后。考虑到半月板在整个膝关节中分配力的基本作用， 与PM有关的膝部力学变化也有牵连。这项研究的目标是确定 哪些膝关节特有的力学因素是PM术后骨性关节炎发生的预测因素。我们的初选 假说是PM后膝关节力(例如接触应力)分布的变化 将构成关节软骨和半月板退变的关键危险因素，独立于 车厢。我们将通过确定哪些机械因素会对 膝关节力量的分布(体外研究)，这是强预测后发展的因素。 PM OA(活体研究)。我们将使用：(A)一种统计驱动的实验验证的计算方法 确定影响接触力的几何特征、组织属性和运动学特征 在完整和PM膝关节上的分布，以及(B)对一组来自Pre-Pre的患者的机械生物学分析。 到PM手术后。通过使用广泛的协同模型(身体、计算、基于患者、 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后膝盖的接触力学发生了重大变化。我们经过实验验证的计算 将与临床医生和更广泛的科学界共享患者分类的模型 PM后OA的风险，其中改良的手术、药物和/或康复技术可能有助于 缓解这些风险因素。