MSKDamage - Image-driven damage characterisation of musculoskeletal tissues for in silico medicine

在英国，肌肉骨骼疾病（关节和背部问题）长期影响着五分之一的人。虽然关节置换术是成功的，但由于创伤、肥胖或其他生活方式的选择，他们受到活跃和年轻人群的需求的挑战。关节和背部疼痛的原因之一是作为关节缓冲的不同软组织的退化。为了延迟或防止全关节置换术，正在开发新的外科干预措施来修复或局部替换这些软组织。目前还没有明确的迹象表明哪些患者从中受益最大。迫切需要确定新的和现有的干预措施对哪种类型的患者最有益。患者的局部解剖结构或组织恶化程度差异很大，目前缺乏生物力学证据来考虑这些巨大的差异，以帮助患者与干预措施相匹配。为了解决这些问题，MSKDamage将开发新的测试方法和工具，将实验室模拟与计算机建模和成像相结合。MSKDamage方法将用于预测在不同程度的关节恶化的一系列处理的力学性能的变化。这将使不同的干预措施与不同患者的特征相匹配。我将集中在三种肌肉骨骼疾病和相关的修复：新兴的治疗方法包括在椎间盘内注射生物材料：我将为特定患者提供个性化的现实测试条件，评估每个患者成功的机会，并确定治疗优化的领域。评估膝关节半月板修复及其与软骨缺损的相互作用：我将提供软骨缺损类型的新信息，减少膝关节半月板置换术成功的机会。这项研究将为半月板置换术中需要修复的软骨缺陷类型提供指导。优化定制腕关节修复：我将帮助优化患者特定的腕关节修复，以减少腕关节肌腱和韧带的损伤。MSKDamage建立在我在该领域的良好记录和工业、临床和学术合作者的网络上，以及我最近的工作，证明了需要包括在脊柱和膝盖退化组织模型中的具体信息。MSKDamage旨在(1)开发一种方法来测试针对特定患者及其特定组织降解的干预措施，(2)开展一系列案例研究，以证明测试一系列组织紊乱和修复的能力。这项工作特别适合获得奖学金，因为它将使我能够开发基本的工程工具和方法，同时与最终用户接触，产生重大的经济和社会影响。我还将发展成为该领域的领导者，领导一个不断壮大的研究小组，并为研究界采取行动，与研究直接相关，倡导公开分享更多的研究成果，以创造更大的影响，并间接作为公众和患者参与医疗保健中计算机模拟研究的大使。

In the UK, musculoskeletal disorders (joint and back problems) affect one in five people long term. While joint replacements are successful, they are challenged by demands of an active and younger population presenting with disorders due to trauma, obesity, or other lifestyle choices. One of the causes for joint and back pain is the deterioration of the different soft tissues acting as cushions in the joints. New surgical interventions are being developed to repair or locally replace those soft tissues in order to delay or prevent a total joint replacement. There is no clear indication yet on which patients benefit the most from them. There is an urgent need to define the type of patients for which new and existing interventions are most beneficial. The local anatomy or level of tissue deterioration differs greatly between patients, and there is currently a lack of biomechanical evidence that takes into account these large variations to help matching patients to interventions. To tackle these issues, this Fellowship, MSKDamage, will develop novel testing methods and tools combining laboratory simulation with computer modelling and imaging. MSKDamage methods will be used to predict the variation in the mechanical performance of a series of treatments at various levels of joint deterioration. This will enable the different interventions to be matched to different patient's characteristics. I will focus on three musculoskeletal disorders and associated repairs:1. Emerging treatments involving the injection of biomaterials in the intervertebral disc: I will produce realistic testing conditions that can be personalised to a specific patient, assessing each patient's chance of success and identifying areas for treatment optimisation.2. Evaluation of meniscus repairs in the knee and their interaction with cartilage defects: I will provide new information on the type of cartilage defect that reduces the chances of success of a meniscus replacement in the knee. The research will develop guidance on the type of cartilage defects that need repair for a meniscus replacement to be successful.3. Optimisation of custom wrist repair: I will help optimise patient-specific wrist repairs so that they reduce the damage in tendons and ligaments in the wrist.MSKDamage builds on my strong track-record in the field and network of industry, clinical and academic collaborators, as well as my recent work that demonstrates the specific information which need to be included in models of degraded tissues in the spine and the knee. MSKDamage aims to (1) develop a methodology to test interventions for a specific patient and its specific tissue degradation, (2) carry out a series of case studies which demonstrate the capacity to test a range tissues disorders and repairs. This work is a particularly suitable for a Fellowship, as it will allow me to develop fundamental engineering tools and methods while engaging with end users for significant economic and societal impact. I will also develop as a leader in the field, leading a growing research group and taking actions for the research community, directly related to the research, with advocacy on sharing more research outcomes openly for creation of more impact, and indirectly related to act as an ambassador for public and patient involvement for research related to computer simulations in healthcare.