Understanding the Mechanical Underpinnings of Rotator Cuff Tear and Surgical Repair

项目摘要 肩袖损伤影响了450万美国人，肩袖损伤患病率的增加与 随着年龄的增长。每年大约有25万例肩袖修复手术，相当于超过30亿例 美元的经济代价。肩袖在日常生活活动中非常重要，因此会造成损伤。 到肩袖会限制独立性和生活质量。肩袖撕裂通常用外科手术治疗。 肌腱再附着；然而，由于再次撕裂的可能性很高，手术并不总是可取的。高 再植手术中的修复紧张不仅在修复过程中具有技术挑战性，而且经常 其次是术后再撕裂，功能能力受限，和/或因关节接触改变而导致的肩部不稳定 力量。因此，一种预测修复张力的方法可能在手术选择中发挥关键作用。修复张力是 术中测量；因此，它不能告知手术决定。外科医生目前必须选择 根据其他磁共振成像参数进行手术修复的患者预后较差 伤势严重。肩袖损伤后，肌肉-肌腱单位发生生理学变化。 包括退缩、肌肉萎缩，以及肌肉内脂肪和纤维组织增加。然而，目前还不清楚 修复张力是否与典型的三个主要临床参数有直接关系 用于确定手术的可行性(肌内脂肪、肌肉萎缩和退缩)。考虑到财务状况 与手术干预相关的成本和患者经历的身体负担，改善了 需要了解影响肩袖损伤和修复张力的因素，以提供更高的 对手术患者的护理水平，从而对数百万美国人的生活质量产生了积极影响。我们的整体 目的是了解肩袖修复的机械支撑，以确定两者之间的关系 生理变化和术后转归。这项研究将提供所需的关键信息 告知手术成功的可能性并更好地预测手术结果，从而指导 肩袖修复手术的实施标准。这项拟议的研究结合了实验和 用于(1)确定肩袖损伤所致生理性损伤之间关系的计算框架 变化和修复张力，以及(2)确定由于肩袖损伤和抬高而产生的生理变化 修复张力影响手术后的结果。

Project Summary Rotator cuff injuries affect 4.5 million Americans and the increase in prevalence of rotator cuff injuries correlates with increasing age. Around 250,000 rotator cuff repairs are performed each year, equating to over three billion dollars in economic cost. The rotator cuff is critically important in activities of daily living, and therefore damage to the rotator cuff can limit independence and quality of life. Rotator cuff tears are commonly treated with surgical reattachment of the tendon; however, surgery is not always advisable due to the high probability of retear. High repair tension during reattachment surgery is not only technically challenging during repair but also is often followed by post-surgical retear, limited functional capacity, and/or shoulder instability due to altered joint contact forces. Thus, a method to predict repair tension could play a key role in surgical selection. Repair tension is intraoperatively measured; therefore, it cannot inform the decision to operate. Surgeons currently must select patients for surgical repair based on other MR imaging parameters associated with poor outcomes and more severe injury. Following injury of the rotator cuff, the muscle-tendon unit undergoes physiological changes including retraction, muscle atrophy, and increased intramuscular fat and fibrous tissue. However, it is unclear whether there is a direct relationship between repair tension and the three main clinical parameters typically used for determining surgical candidacy (intramuscular fat, muscle atrophy, and retraction). Given the financial costs associated with surgical intervention and the physical burden experienced by patients, an improved understanding of the factors that influence rotator cuff injury and repair tension are needed to provide a higher level of care for surgery patients, thus positively impacting the quality of life for millions of Americans. Our overall objective is to understand the mechanical underpinnings of rotator cuff repair to identify relationships between physiological changes and post-surgical outcomes. This research will provide crucial information needed to inform likelihood of surgical success and better predict surgical outcomes, thereby guiding development of a standard of practice for rotator cuff repair surgery. The proposed research combines an experimental and computational framework to (1) determine the relationship between rotator cuff injury-induced physiological changes and repair tension, and (2) determine how physiological changes due to rotator cuff injury and elevated repair tension influences post-surgical outcomes.