Dynamic Instability in Persons with Knee Osteoarthritis

描述(申请人提供)：膝盖骨关节炎(OA)是导致慢性残疾的主要原因。膝关节骨性关节炎进展超过轻度阶段是膝关节骨性关节炎整体成本的主要原因。预防膝骨性关节炎疾病进展或膝骨性关节炎相关残疾的策略很少，这在很大程度上是由于对导致这些结果的因素了解有限。近年来，流行病学研究发生了转变，更多地关注骨性关节炎的进展，而不是最初的骨性关节炎发展。此外，人们越来越多地认识到当地因素所起的作用。膝关节的稳定性对于日常活动表现和在活动中保护关节免受损伤都是至关重要的。膝关节不稳定包括一系列症状和可测量的现象，这些症状和可测量的现象彼此之间可能没有什么关系，包括对膝盖的信心不足、屈曲或屈服的发作，以及膝盖在特定平面上的过度运动。在这项应用中，我们建议通过MRI检查膝关节低信心、膝关节不会弯曲的低信心、较高的屈曲频率和基线步态期间额面过度运动对膝关节骨性关节炎患者基线至两年的身体功能下降和软骨丢失的影响。为了最大限度地提高效率和减少预算，这项研究建立在最近由我们的多学科临床研究中心(MCRC)拨款竞争续期资助的膝骨性关节炎自然史研究的基础上。通过MCRC项目，该项目侧重于髋部肌肉参数，没有动态不稳定性的评估，已经为膝骨性关节炎队列的基线和两年评估提供了资金(包括拟议研究所需的协变量和结果数据)。我们现在请求提供资金，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联合一级和个人一级的成果联系起来的假设。拟议的项目也是一个竞争性的续签申请，以我们正在进行的RO1周期的成果为基础，并对其进行扩展。这项拟议研究的结果将为膝骨性关节炎的物理和康复治疗的发展提供信息，这些治疗可能针对动态不稳定的特定方面。这是膝关节环境中一个关键的、可改变的组成部分，很少受到关注，尽管动态不稳定在保持膝关节完整性和人的水平功能方面可能起到很大的作用。公共卫生相关性：膝盖骨关节炎(OA)是致残的主要原因。几乎没有预防骨性关节炎疾病进展或骨性关节炎相关功能衰退的策略存在。我们建议检查膝关节信心、膝关节不会弯曲的信心、屈曲发作的频率和在定量步态分析中测量的不稳定对膝关节骨关节炎患者的关节软骨丢失和身体功能下降的影响。这项拟议研究的结果将有助于开发针对动态不稳定的特定方面的膝骨性关节炎的物理和康复治疗。这是膝关节环境中一个关键的、可改变的组成部分，在膝关节骨性关节炎中很少受到关注，尽管稳定性在保持膝关节完整性和个人水平的功能方面具有潜在的重要作用。

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.