A computer modeling tool for optimizing Meniscus Allograft Transplantation

描述（由申请人提供）：半月板同种异体移植已成为接受完整或接近完整半月板切除术的有症状患者的可行治疗选择。初步的基础和临床研究表明，同种异体半月板移植可能有助于减轻疼痛和改善膝关节功能。然而，移植恢复半月板切除术损害的正常半月板功能的有效性尚未得到严格的评估。临床研究和基础科学研究都缺乏一致的证据。严重缺乏定量的体内数据和半月板同种异体移植如何影响膝关节功能和力学的机制描述。这些数据和知识库不仅为优化临床护理提供了直接的、最相关的科学依据，而且对于指导组织工程半月板构建体的发展也是非常需要的。该研究首次尝试通过研究同种异体半月板移植对体内和计算机中胫骨股骨运动学和接触一致性的影响来建立这样一个知识库。我们的长期目标是建立一个生物力学的科学基础和计算机临床应用程序来设计个体化优化的同种半月板移植。我们的具体目标是(1)描述患者在半月板移植手术治疗前后在日常活动（水平行走，下蹲）中胫骨股骨运动学和接触一致性的体内变化，以及(2)开发和验证一个计算机模型，该模型可以机械地描述不同特征的半月板移植对关节运动学和接触一致性的影响。我们将使用动态双翼x线摄影系统测量10名患者的胫股运动学，使用无线肌电图系统测量肌肉激活，使用光学运动捕捉系统和仪器化跑步机测量全身运动学-动力学。我们将获得患者的高分辨率计算机断层扫描（CT）和磁共振成像（MRI）扫描。有了这些数据，我们将使用前向动态模拟和有限元建模相结合的方法开发针对患者的模型。我们将根据患者内部和患者之间的预测来验证模型。这些研究目标的成功实现将为我们未来追求个体优化的半月板移植奠定新的生物力学基础和有效的建模框架，不仅可以恢复关节一致性，还可以促进长期关节健康。

DESCRIPTION (provided by applicant): Meniscus allograft transplantation has become a viable treatment option for selected symptomatic patients who have undergone a complete or near-complete meniscectomy. Preliminary basic and clinical studies have suggested that meniscus allograft transplantation may help alleviate pain and improve knee function. However, the efficacy of transplantation to restore normal meniscus function compromised by meniscectomy has not been rigorously evaluated. There has been a scarcity of converging evidence from both clinical and basic science studies. Critically lacking are quantitative in vivo data and mechanistic descriptions of how meniscus allograft transplantation affects the knee joint function and mechanics. Such data and knowledge bases not only provide direct, most relevant scientific evidence for optimizing the clinical care, but also are much needed for guiding the development of tissue-engineered meniscus constructs. The proposed research is the first attempt to develop such a knowledge base by studying the effects of meniscus allograft transplantation on tibiofemoral kinematics and contact congruency in vivo and in silico. Our long-term goal is to establish a biomechanical science base and a computerized clinical utility for designing individual-optimized meniscus allograft transplantation. Our specific aims are (1) to characterize the in vivo changes in tibiofemoral kinematics and contact congruency in patients before and after treatment with meniscal transplant surgery during daily activities (level walking, squatting), and (2) to develop and validate a computational in silico model that describes mechanistically the effects of meniscus transplantation of varied characteristics on joint kinematics and contact congruency. We will measure 10 patients' tibiofemoral kinematics using a dynamic biplane radiography system, muscle activations using a wireless EMG system, and whole-body kinematics- kinetics using an optical motion capture system along with an instrumented treadmill. We will obtain high- resolution computed tomography (CT) and magnetic resonance imaging (MRI) scans of the patients. With the data, we will develop patient-specific models using an approach combining forward dynamic simulation and finite element modeling. We will validate the model based on both within-patient and cross-patient predictions. Successful fulfillment of these research aims will build a new biomechanical science foundation and a validated modeling framework for our future pursuit of individual-optimized meniscus transplantation that not only restores joint congruency but also promotes long-term joint health. PUBLIC HEALTH RELEVANCE: Meniscectomy is the most common orthopaedic surgical procedure performed in the United States and has deleterious consequences such as osteoarthritis and muscle dysfunction. Although meniscus transplant surgery has become a viable treatment option to restore normal meniscus function compromised by meniscectomy, its efficacy has not been rigorously evaluated. This grant application seeks to study the effects of meniscus allograft transplantation on tibiofemoral kinematics and contact mechanics using computer models developed from in vivo data.