Improving the Detection, Classification and Treatment of Misaligned Arthritic Ankles

踝关节骨关节炎(OA)是一种使人虚弱和活动受限的疾病。它通常源于 创伤的结果--这种创伤在服兵役中发病率很高。如果软骨不是 在创伤严重受损的情况下，关节的稳定性和对齐度可能会受到影响。随着时间的推移，一个不稳定或 由于运动学的异常，错位的踝关节可能会经历软骨磨损的异常率。 虽然骨性关节炎可能需要几十年的时间才能发展，但这种创伤导致的关节炎状态最终将需要 踝关节置换或融合，后果会带来巨大的经济负担和生活质量的影响。 关于对齐，特别是在冠状平面上，目前的临床诊断依赖于静态X- 脚踝的射线。静态图像可能并不表示步态过程中的动态未对齐。更进一步说， 楔形鞋垫是一种潜在的保守治疗方法，对恢复踝关节功能的作用尚无文献报道。 这项提议旨在使用双平面透视，一种基于X射线的动态成像方法来测量 膝关节炎受试者(内翻、中立位和外翻)和对照组的踝关节运动学研究。有了这个 方法：测量步态过程中的胫距运动学。此外，被归类为中性的受试者 他们的静态X光片，但在步态过程中表现出脚踝内翻或外翻对齐，将被识别。 提高诊断结果的准确性为患者组提供了更多的途径 治疗。我们将研究我们的3D运动学和临床2D成像之间的相关性--这是有益的 临床诊断学。我们还将能够测量楔形鞋垫对脚踝修复的影响。 功能。考虑到这一点，提出了以下目标和方法。 具体目标1：研究对照和骨关节炎受试者的踝关节运动学。在……里面 具体目标1，将招募90名踝关节骨性关节炎受试者(内翻、中性或外翻对齐各30人 脚踝)。我们还将招募20名对照受试者。受试者将接受足部CT扫描，以量化骨骼 几何学(这是双平面透视的必要步骤)。受试者随后将在双翼飞机系统中进行成像 步态试验，并穿着中性学习鞋。这将在步态中为这些人产生Tibio-Talar运动学 人口。具体目标2：在符合以下条件的骨性关节炎受试者中识别动态错位的踝关节 目前使用静态分析归类为中性对齐。我们将比较静态X射线和 OA受试者的步态运动学，特别是那些临床确定的中性排列的受试者。我们会 确定中性骨性关节炎受试者在步态过程中实际表现出不对齐的比例，因此 分类不正确。我们还将根据我们的3D数据重新创建2D临床X光视图，试图 将我们的改进(使用3D透视)转化为更准确地将对齐分类为临床2D 诊断。具体目标3：评估侧方或内侧楔入修复的潜力 失调的踝关节骨性关节炎受试者的对齐情况。OA受试者将被拍到穿着有楔子的鞋子 鞋垫与它们的错位类型相对应。中立的骨关节炎受试者，他们表现出不一致 在步态过程中，将被召回进行楔形鞋垫治疗。这就产生了保守的治疗运动学。 这项研究将生成描述对照和踝关节骨关节炎受试者运动学的基线数据。这 目前文献中还没有数据，这是对该领域的一项新贡献。第二，这个 建议决定了当前2D X射线方法在检测动态未对准方面的精确度。这 信息可以让临床医生了解他们诊断工具的准确性，并可能导致改进。 第三，这项提议将产生数据来评估楔形鞋垫对保守派的效用 踝关节错位的处理。总而言之，这项研究对诊断具有直接影响 以及治疗踝关节骨性关节炎。最后，还有许多额外的分类、诊断和 为了退伍军人的利益进行预防性研究，这将源于这个职业发展奖。

Ankle osteoarthritis (OA) is a debilitating and mobility limiting condition. It can commonly stem from the result of a traumatic injury – such trauma has a high prevalence in military service. If cartilage is not severely damaged in that trauma, the stability and alignment of the joint may be. Over time, an unstable or misaligned ankle joint can experience abnormal rates of cartilage wear and tear due to aberrant kinematics. While OA may take decades to develop, the resulting arthritic state from this trauma will ultimately require ankle replacement or fusion, consequences with a tremendous financial burden and quality of life impact. With regards to alignment, particularly in the coronal plane, current clinical diagnosis relies on static X- ray of the ankle joint. Static images may not indicate dynamic misalignment during gait. Further, the effect of wedged insoles, a potential conservative treatment, on the restoration of ankle function is undocumented. This proposal aims to use biplane fluoroscopy, an X-ray based dynamic imaging approach, to measure ankle kinematics in OA subjects (with varus, neutral and valgus ankle alignment) and controls. With this method, tibio-talar kinematics during gait can be measured. Furthermore, subjects classified as neutral from their static radiograph, but that exhibit ankle varus or valgus alignment during gait, will be identified. Improving the accuracy of a diagnostic outcome provides a patient group with additional avenues for treatment. We will investigate correlations between our 3D kinematics and clinical 2D imaging – to the benefit of clinical diagnostics. We will also be able to measure the effect of wedged insoles on the restoration of ankle function. With this in mind, the following aims and methodology are proposed. Specific Aim 1: To investigate ankle kinematics in controls and subjects with OA. In support of Specific Aim 1, 90 ankle OA subjects will be recruited (30 each of varus, neutral or valgus aligned ankles). We will also recruit 20 control subjects. Subjects will receive CT scans of their feet to quantify bone geometry (a step necessary for biplane fluoroscopy). Subjects will then be imaged in the biplane system during gait trials and while wearing neutral study shoes. This will yield tibio-talar kinematics during gait for these populations. Specific Aim 2: To identify dynamically misaligned ankles in OA subjects who are currently classified as neutrally aligned using static analysis. We will compare the static X-ray and the gait kinematics of OA subjects, particularly those with clinically determined neutral alignment. We will determine what proportion of neutral OA subjects actually exhibit misalignment during gait and are thus improperly categorized. We will also re-create 2D clinical X-ray views from our 3D data in an attempt to translate our improvement (with 3D fluoroscopy) to more accurately classify alignment to clinical 2D diagnostics. Specific Aim 3: To evaluate the potential of lateral or medial wedging to restore alignment in misaligned ankle OA subjects. OA subjects will be imaged wearing shoes with wedged insoles which correspond to their type of misalignment. Neutral OA subjects, who demonstrate misalignment during gait, will be recalled for a wedged insole session. This yields conservative treatment kinematics. This study will generate baseline data describing the kinematics of control and ankle OA subjects. This data is not currently available in the literature, and represents a novel contribution to the field. Second, this proposal determines how accurate current 2D X-ray methods are at detecting dynamic misalignment. This information can inform clinicians about the accuracy of their diagnostic tools, and may lead to improvements. Third, this proposal will generate data to evaluate the utility of wedged insoles for the conservative management of ankle misalignment. In Summary, this study has immediate impact potential on the diagnosis and treatment of ankle OA. Last, there are numerous additional avenues of classification, diagnostic, and preventative research for the benefit of the veterans which will stem from this Career Development Award.