Dynamic Instability in Persons with Knee Osteoarthritis

描述（由申请人提供）：膝关节骨关节炎（OA）是慢性残疾的主要原因。进展超过轻度阶段的膝关节OA是整个膝关节OA成本的主要原因。几乎没有预防膝关节OA疾病进展或OA相关残疾的策略，这在很大程度上是由于对这些结局的因素了解有限。近年来，流行病学研究发生了转变，更多地关注OA的进展，而不是最初的OA发展。此外，人们日益认识到当地因素所发挥的作用。膝关节稳定性对于日常活动性能和保护关节免受活动期间的损伤都至关重要。膝关节不稳定包括一系列症状和可测量现象，这些症状和现象之间可能没有什么关系，包括膝关节信心不足、屈曲或屈服发作以及膝关节在特定平面内的过度运动。在本申请中，我们建议通过MRI检查膝关节OA患者的基线至2年身体功能下降和软骨损失的基线时，检查膝关节置信度低、膝关节不会屈曲的置信度低、屈曲频率较高和步态期间额状面运动过度的影响。为了最大限度地提高效率并减少预算，本研究建立在膝关节OA自然史研究的基础上，该研究最近在我们的多学科临床研究中心（MCRC）资助的竞争性更新中获得资助。通过MCRC项目，重点关注髋关节肌肉参数，没有评估动态不稳定性，已经资助了膝关节OA队列的基线和两年评价（包括拟议研究所需的协变量和结局数据）。我们现在要求提供资金，以增加对动态不稳定症状和措施的评估，并测试将这些措施与关节水平和个人水平结果相关联的假设。拟议的项目也代表了一个竞争性的更新申请，建立在并扩展了我们正在进行的RO1周期的结果。拟议研究的结果将为膝关节骨性关节炎的物理和康复治疗提供信息，这些治疗可能针对动态不稳定的特定方面。这是膝关节环境的一个关键的、可修改的组成部分，很少受到关注，尽管动态不稳定在膝关节完整性和个人水平功能的保持中可能发挥很大的作用。公共卫生相关性：膝关节骨关节炎（OA）是残疾的主要原因。几乎没有预防OA疾病进展或OA相关功能下降的策略。我们建议检查膝关节的信心，信心，膝关节不会屈曲，屈曲发作的频率，和不稳定性定量步态分析期间测量的关节软骨损失和身体功能下降的一个队列的人与膝关节骨性关节炎的影响。拟议研究的结果将有助于开发针对动态不稳定特定方面的膝关节OA物理和康复治疗。这是膝关节环境的一个关键的、可改变的组成部分，在膝关节OA中很少受到关注，尽管在保持膝关节完整性和个人水平功能方面稳定性可能发挥很大作用。

DESCRIPTION (provided by applicant): Osteoarthritis (OA) at the knee is a leading cause of chronic disability. Knee OA that progresses beyond mild stages is responsible for much of the cost of knee OA as a whole. Few strategies to prevent knee OA disease progression or OA-related disability exist, in large part due to limited knowledge of factors responsible for these outcomes. In recent years, there has been a shift in epidemiological studies to concentrate more on OA progression than on initial OA development. Also, there is a growing recognition of the role played by local factors. Knee stability is crucial both to daily activity performance and to protection of the joint against damage during activity. Knee instability encompasses a spectrum of symptoms and measurable phenomena, which may bear little relation to each other, including low confidence in the knees, episodes of buckling or giving way, and excessive motion at the knee in a specific plane. In this application, we propose to examine the effect of low knee confidence, low confidence that the knee will not buckle, higher buckling frequency, and excessive frontal plane motion during gait at baseline on baseline-to-two-year physical function decline and cartilage loss by MRI in persons with knee OA. To maximize efficiency and reduce the budget, this study builds off the knee OA natural history study recently funded within the competing renewal of our Multidisciplinary Clinical Research Center (MCRC) grant. Through the MCRC project, which focuses on hip muscle parameters and has no assessment of dynamic instability, baseline and two-year evaluations of a cohort with knee OA are already funded (including the covariate and outcome data the proposed study requires). We now request funding to add the assessments of dynamic instability symptoms and measures and to test the hypotheses relating these measures to joint-level and person-level outcomes. The proposed project also represents a competing renewal application, building upon and extending our results from the ongoing RO1 cycle. Results from the proposed study will inform development of physical and rehabilitative therapy for knee OA that might target specific aspects of dynamic instability. This is a key, modifiable component of the knee joint environment that has received little attention, despite a potentially large role of dynamic instability in the preservation of knee joint integrity and person-level functioning. PUBLIC HEALTH RELEVANCE: Osteoarthritis (OA) at the knee is a major cause of disability. Few strategies to prevent OA disease progression or OA-related function decline exist. We propose to examine the effect of knee confidence, confidence that the knee will not buckle, frequency of buckling episodes, and instability measured during quantitative gait analysis on joint cartilage loss and physical function decline in a cohort of persons with knee OA. Results from the proposed study will aid development of physical and rehabilitative therapy for knee OA that might target specific aspects of dynamic instability. This is a key, modifiable component of the knee joint environment that has received little attention in knee OA, despite a potentially large role for stability in the preservation of knee joint integrity and person-level functioning.