Quantitative measurement of soft tissue knee balance after TKA using ultrasound elastography

 描述（由申请人提供）：全膝关节置换术（TKA）已成为在膝关节骨关节炎晚期恢复膝关节功能和缓解疼痛的最广泛使用的手术之一;但早期TKA失败（术后<10年）仍然是一个大规模问题。虽然膝关节不稳定是早期失败的主要原因，但目前用于测量膝关节平衡的方法在很大程度上是主观的和用户依赖的。超声弹性成像（UE）是一项创新技术，能够无创量化软组织位移和应变，这是平衡的重要指标。我们最近开发了这样一种技术来评估跟腱变形，并认为这种方法可以提供重要的洞察膝关节软组织力学。本研究的前提是使用这种无创UE方法原位测量膝关节平衡，然后在患者人群中更好地了解TKA对膝关节平衡改变的影响，总体目标是为该方法的术中整合铺平道路。在目标1中，将从膝关节软组织（内侧和外侧副韧带、髌腱）中收集超声数据，同时在膝关节运动试验台中进行功能加载。然后将使用我们的UE方法计算组织位移和应变。UE的结果将与当前的黄金标准方法（数字图像相关; DIC）进行比较，以进行校准，然后进行精度评估。然后由整形外科医生对样本进行TKA，通过过度填充膝关节内侧或外侧组件来改变膝关节平衡。将评估UE测量对这些改变的平衡条件的灵敏度。这一目标的一个重要成果也将是验证数据集（超声数据，DIC和运动学）的公开共享。在目标2中，将在健康成人（n=20）和既往TKA的成人中评价软组织力学，证明稳定性可接受（n=20）和不可接受（n=20）。UE计算的位移和应变的比较将有助于了解TKA对膝关节稳定性的影响。最后，在目标3中，将汇编这些结果，并使用判别函数分析来确定哪些任务和措施为临床评估提供最佳区分力。这些数据将与临床见解相结合，为UE的临床整合提供建议，以评估软组织膝关节平衡。成功完成这些目标将有助于改善每年接受TKA手术的60多万美国人的TKA结局，并将指出可以改善TKA结局的特定术中技术。

 DESCRIPTION (provided by applicant): Total knee arthroplasty (TKA) has become one of the most widely used procedures for restoring knee function and relieving pain in the advanced stages of knee osteoarthritis; yet early TKA failure (<10 years post-surgery) remains a large-scale problem. Although knee instability is known to be a major cause of early failures, current methods for measuring knee balance are largely subjective and user-dependent. Ultrasound elastography (UE) is an innovative technology that enables the noninvasive quantification of soft tissue displacements and strains, which are important indicators of balance. We have recently developed such a technique for the evaluation of Achilles tendon deformation, and believe that this approach could provide important insight into knee soft tissue mechanics. The premise of this study is to use this noninvasive UE approach to measure knee balance in situ and then in patient populations to better understand the effects of TKA on altered knee balance, with the overall goal to pave the way toward intra-operative integration of this approach. In Aim 1, ultrasound data will be collected from cadaveric knee soft tissues (medial and lateral collateral ligament, patellar tendon) while functionally loaded in a kinematic knee rig. Tissue displacements and strains will then be computed using our UE approach. Results from UE will be compared with the current gold standard approach (digital image correlation; DIC) to enable calibration and then accuracy assessment. TKAs will then be performed on the specimens by an orthopedic surgeon, and altered knee balance will be imposed by overstuffing the medial or lateral components of the knee. The sensitivity of UE measurements to these altered balance conditions will be assessed. An important outcome of this aim will also be the public sharing of the validation dataset (ultrasound data, DIC and kinematics). In Aim 2, soft tissue mechanics will be evaluated in healthy adults (n=20), and adults with a prior TKA demonstrating acceptable (n=20) and unacceptable (n=20) stability. Comparison of UE- computed displacements and strains will provide insight into the effects of TKA on knee stability. Finally, in Aim 3, these results will be compiled and discriminant function analysis will be used to determine which tasks and measures provide the best discriminating power for clinical assessment. These data will be paired with clinical insight to provide recommendations for clinical integration of UE for the assessment of soft tissue knee balance. Successful completion of these aims will contribute to improving the outcomes of TKA for the more than 600,000 Americans who annually undergo this procedure, and will point to specific intra-operative techniques that can improve TKA outcomes.