A computer modeling tool for optimizing Meniscus Allograft Transplantation

描述(申请人提供)：同种异体半月板移植已成为经过完全或接近完全切除半月板切除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，移植修复半月板切除所损害的正常半月板功能的效果还没有得到严格的评估。临床研究和基础科学研究都缺乏统一的证据。目前缺乏半月板移植如何影响膝关节功能和力学的体内定量数据和力学描述。这些数据和知识库不仅为优化临床护理提供了最直接、最相关的科学证据，而且对于指导组织工程半月板构建的发展也是非常必要的。这项研究是首次尝试通过研究同种异体半月板移植对活体和硅胶中胫股运动学和接触一致性的影响来建立这样的知识库。我们的长期目标是为设计个体化的同种异体半月板移植物建立生物力学基础和计算机化的临床应用。我们的具体目标是(1)描述半月板移植手术治疗前后患者在日常活动(水平行走、蹲下)过程中胫股运动学和接触一致性的活体变化，以及(2)建立和验证一个计算模型，该模型从力学上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。我们将使用动态双平面摄影系统测量10名患者的胫股运动学，使用无线肌电系统测量肌肉激活，并使用光学运动捕捉系统和仪表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体层摄影(CT)和磁共振成像(MRI)扫描。有了这些数据，我们将使用正向动态模拟和有限元建模相结合的方法来开发针对患者的模型。我们将基于患者内部和患者间的预测来验证该模型。这些研究目标的成功实现将为我们未来追求的个性化半月板移植建立新的生物力学科学基础和有效的建模框架，不仅恢复关节的一致性，而且促进长期的关节健康。 公共卫生相关性：半月板切除术是美国最常见的骨科外科手术，具有骨关节炎和肌肉功能障碍等有害后果。尽管半月板移植手术已经成为恢复因半月板切除而受损的正常半月板功能的一种可行的治疗选择，但其疗效尚未得到严格的评估。这项资助申请旨在利用从活体数据开发的计算机模型来研究同种异体半月板移植对胫股运动学和接触力学的影响。

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.