Walk this Way: Physical Activity and Walking Biomechanics Lead to Early Knee OA Symptoms and Ultrasound-Detected Structural Pathology after ACL Reconstruction

项目总结 在美国，每年约有25万人发生前十字韧带(ACL)损伤，主要是 接受外科重建(ACLR)治疗。然而，对于至少三分之一患有ACLR的年轻人来说，这种损伤 手术和手术是导致慢性疼痛、降低长期生活质量和增加 患骨性关节炎(OA)的风险。ACLR术后第一年对患者的长期预后至关重要 有证据表明，ACLR术后1年的疼痛水平和生活质量将保持不变，最高可达 十年了。此外，在ACLR术后1年，约33%的年轻人存在膝关节结构病变。 不幸的是，在ACLR后的第一年里，没有基于证据的策略来识别哪些人是 有慢性症状或结构病理的风险。因此，我们无法确定易感人群和缺乏 对哪些可改变的风险因素可以降低其风险并防止终身残疾的关键见解。 在ACLR术后1年中常见的潜在的可改变的危险因素是行走的改变 生物力学和体力活动水平不足。由于不良的症状和放射学前的结构 病理是膝骨性关节炎发生的危险因素，了解与以下因素相关的可改变的危险因素 ACLR术后第一年的不良症状和结构结果需要进一步的研究来确定 预防骨性关节炎的疗法。这项研究的目的是确定PA和步行的纵向变化 ACLR术后3个月、6个月、9个月和12个月的生物力学评估与不良症状或结构结果有关 在ACLR术后的第一年。这将是第一项将以下结果应用于以下年轻人的研究 ACLR术后第一年多次就诊：1)早期骨性关节炎症状的分类标准，2)临床 便于使用的全膝关节超声评分系统，可检测多种结构病变。将对PA进行评估 使用研究级加速度计来量化中等强度到剧烈强度的PA的每天步数和每周分钟数 在每次学习访问后的7天内。行走的生物力学将在运动捕捉中进行评估 实验室用来量化垂直地面反作用力和膝关节内收力矩。我的中心假设 ACLR术后PA和行走生物力学有适度变化的参与者将不太可能 第一年的症状和结构结果较快的患者差 增加或不增加PA和步行生物力学。这项工作的预期结果是确定：1)在- ACLR术后的风险患者，是预防不良症状的临床试验的理想参与者 和结构结果，以及2)当PA或行走生物力学需要在术后1年内达到目标时 ACLR。这项建议还将为私人投资公司提供培训和指导，以发展一套全新的技能- 膝关节超声成像、基于设备的PA监测、纵向数据分析和临床试验设计。这 培训和指导将直接导致R34临床试验计划拨款，以开发使用步态的临床试验 再培训或PA推广，以防止ACLR术后高危患者出现不良症状或结构性结果。

PROJECT SUMMARY About 250,000 anterior cruciate ligament (ACL) injuries occur annually in the United States and are primarily treated with a surgical reconstruction (ACLR). However, for at least 1 in 3 young adults with an ACLR, the injury and surgery are pivotal life events that lead to chronic pain, diminished long-term quality of life, and an increased risk for osteoarthritis (OA). The 1st year post-ACLR is critical to a patient’s long-term outcomes as there is evidence that levels of pain and quality of life experienced at 1 year post-ACLR will remain unchanged for up to 10 years. Additionally, at 1 year post-ACLR, ~33% of young adults present with knee structural pathologies. Unfortunately, there are no evidence-based strategies to identify people during the 1st year post-ACLR who are at risk for chronic symptoms or structural pathology. Hence, we cannot identify susceptible populations and lack critical insights into which modifiable risk factors could decrease their risk and prevent lifelong disability. Potentially modifiable risk factors that are common throughout the 1st year post-ACLR are alterations in walking biomechanics and insufficient levels of physical activity. Since poor symptoms and pre-radiographic structural pathology are risk factors for the development of knee OA, understanding modifiable risk factors that relate to poor symptomatic and structural outcomes during the 1st year post-ACLR is needed for future studies to identify therapies that prevent OA. The objective of this study is to determine how longitudinal changes in PA and walking biomechanics assessed at 3, 6, 9, and 12 months post-ACLR relate to poor symptomatic or structural outcomes during the 1st year post-ACLR. This will be the first study that applies the following outcomes to young adults at multiple visits during the 1st year post-ACLR: 1) classification criteria for early OA symptoms, 2) clinically accessible whole-knee ultrasound scoring system to detect multiple structural pathologies. PA will be assessed with research-grade accelerometers to quantify steps per day and weekly minutes of moderate to vigorous PA during a 7-day period following each study visit. Walking biomechanics will be assessed in a motion capture laboratory to quantify vertical ground reaction force and internal knee adduction moment. My central hypothesis is that participants with a moderate change in PA and walking biomechanics post-ACLR will be less likely to have poor symptomatic and structural outcomes during the 1st year when compared to people with a rapid increase or no change in PA and walking biomechanics. The expected outcome of this work is to identify: 1) at- risk patients post-ACLR who are the ideal participants for clinical trials aimed at preventing poor symptomatic and structural outcomes, and 2) when PA or walking biomechanics need to be targeted during the 1st year post- ACLR. This proposal will also provide the PI with the training and mentoring to develop a novel skill set in whole- knee ultrasound imaging, device-based PA monitoring, longitudinal data analyses, and clinical trial design. This training and mentoring will directly lead to an R34 clinical trial planning grant to develop a clinical trial using gait retraining or PA promotion to prevent poor symptomatic or structural outcomes in high-risk patients post-ACLR.