In Vivo PCL Biomechanics

描述（由申请方提供）：未经治疗的PCL损伤的自然病程是膝关节内侧和髌股间室最终发生退行性变化。然而，PCL损伤的手术治疗并未显著改善结局，因为据报道，20 - 60%的患者在手术治疗后出现关节炎。膝关节运动学改变被认为会导致长期关节退化。然而，PCL在体内的生物力学作用尚不清楚。关于PCL在体内活动期间的功能的数据很少。手术治疗PCL缺陷的进展需要准确了解完整膝关节的体内PCL功能。 该项目的主要目的是使用一种新的成像技术确定PCL在体内膝关节屈曲过程中对膝关节功能的影响。将使用正交荧光镜和MRI扫描，在被动和负重屈曲期间从健康志愿者获得正常膝关节的体内运动学。然后将确定胫骨和股骨上PCL附着区域的相对位置。将准确量化体内膝关节运动期间PCL的伸长和扭曲。为了量化PCL损伤对体内膝关节运动学的影响，将使用相同的图像技术研究单侧PCL断裂患者。将确定受伤和完好对侧膝关节的运动。此外，该技术还将使我们能够确定PCL对胫股和髌股关节接触生物力学的影响，包括测量PCL断裂引起的关节软骨-软骨接触面积和体内位置的变化。 这些数据将为外科医生在治疗PCL损伤时提供准确的体内目标。因此，拟议的研究将对PCL缺陷的临床管理产生直接影响。从长远来看，我们将开发一种优化的手术技术，用于治疗PCL损伤，旨在恢复正常的体内膝关节功能。正交透视成像和MRI技术在本研究中的创新使用将是开发PCL和后外侧结构损伤组合的最佳治疗的宝贵工具。我们的成像技术将进一步适用于其他软组织损伤，如软骨缺损和软组织缺损的肩，髋，腕，踝和脊柱。

DESCRIPTION (provided by applicant): The natural history of an untreated PCL injury is the eventual development of degenerative changes in the medial and patellofemoral compartments of the knee. However, the surgical treatment of PCL injuries has not significantly improved outcomes, as joint arthrosis has been reported in 20 to 60% of patients after operative management. Altered knee kinematics has been assumed to cause long term joint degeneration. However, the biomechanical role of the PCL in vivo is unclear. There is little data on the PCL function during in vivo activities. Advancements in surgical treatment of PCL deficiency require an accurate knowledge of in vivo PCL function in the intact knee. The broad aim of this project is to determine the effect of the PCL on knee function during in vivo knee flexion using a novel imaging technique. In vivo kinematics of normal knees will be obtained from healthy volunteers during passive and weight bearing flexion, using orthogonal fluoroscopic and MRI scans. The relative positions of the PCL attachment areas on the tibia and femur will then be determined. The elongation and twist of the PCL during in vivo knee motion will be accurately quantified. To quantify the effect of PCL injury on knee kinematics in vivo, patients with unilateral PCL rupture will be investigated using the same image technique. Kinematics of both injured and intact contralateral knees will be determined. Further, this technique will also allow us to determine the effect of the PCL on tibiofemoral and patellofemoral joint contact biomechanics, including the measurement of changes in the articular cartilage-cartilage contact areas and locations in vivo caused by PCL rupture. The data will provide surgeons with an accurate in vivo objective when treating PCL injuries. The proposed investigation will thereby have a direct impact on the clinical management of PCL deficiency. In the long term, we will develop an optimized surgical technique for the treatment of PCL injuries aimed at restoring normal in vivo knee function. The innovative usage of orthogonal fluoroscopic imaging and MRI technology in this investigation will be an invaluable tool for the development of optimal treatments of combined PCL and posterolateral structure injuries. Our image technique will be further applicable to other soft tissue injuries such as cartilage defects and soft tissue defects in the shoulder, hip, wrist, ankle and spine.