The overall goal of this project is to address the problem of premature osteoarthritis of the knee in patients following anterior cruciate ligament (ACL) injury by conducting a prospective study to fill critical gaps in the available knowledge on the nature of walking mechanics changes, graft function and cartilage thinning following ACL reconstruction. This work is important since ACL loss often leads to premature degenerative arthritis of the knee even when the ACL is reconstructed and there is increasing evidence that there are kinematic and kinetic changes at the knee during walking following ACL injury or reconstruction that influence cartilage changes over time. Preliminary work for this project has demonstrated that changes in tibiofemoral motion of the ACL deficient knee during walking were associated with cartilage thinning in the tibiofemoral joint and a significant relationship between graft placement and ambulatory mechanics was observed following ACL reconstruction. Patients operated within 3 months following ACL injury will be studied at 2 years following reconstruction (to ensure remodeling is stable) and at 4 years after surgery. A matched control population will also be studied over the same interval. The study will address the following specific aims: 1) To determine if ambulatory kinematics in patients with ACL reconstruction are influenced by graft placement. 2.) To determine if there are detectable thickness changes in the weight bearing regions of tibiofemoral cartilage over a 2 year period following ACL reconstruction that are greater than a matched healthy control group 3) To determine if specific characteristics of walking mechanics of the ACL reconstructed knees remain unchanged, or change no more than matched healthy knees, between 2 and 4 years after reconstruction for clinically successful grafts. This study will use a combination of in vivo gait analysis and 3.0T magnetic resonance imaging. Using algorithms developed by our group, we can estimate the 6 degree-of-freedom motion of the tibiofemoral joint including internal tibial rotation and anterior tibial translation. Custom algorithms also allow for the high- resolution measurement of cartilage thickness across weight-bearing regions of the cartilage. This project is important clinically since the information generated from this study will helps to isolate the some critical factors that can influence premature osteoarthritis following ACL reconstruction and thus can be used to inform improved methods for treatment planning, reconstruction and rehabilitation.

Public Health Relevance

The overall goal of this project is to address the problem of premature osteoarthritis of the knee in patients following anterior cruciate ligament (ACL) injury and treated with an ACL reconstruction using a graft. This study will fill critical gaps in the available knowledge on the nature of walking mechanics changes, graft function and cartilage thinning following ACL reconstruction. This work is important since ACL loss often leads to premature degenerative arthritis of the knee even when the ACL is reconstructed and there is increasing evidence that there are kinematic and kinetic changes at the knee during walking following ACL injury or reconstruction that influence cartilage changes over time.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR039421-17
Application #
8392988
Study Section
Skeletal Biology Structure and Regeneration Study Section (SBSR)
Program Officer
Panagis, James S
Project Start
1988-04-01
Project End
2014-11-30
Budget Start
2012-12-01
Budget End
2014-11-30
Support Year
17
Fiscal Year
2013
Total Cost
$385,934
Indirect Cost
$143,133
Name
Stanford University
Department
Surgery
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Erhart-Hledik, Jennifer C; Chu, Constance R; Asay, Jessica L et al. (2018) Longitudinal changes in knee gait mechanics between 2 and 8 years after anterior cruciate ligament reconstruction. J Orthop Res 36:1478-1486
Favre, Julien; Erhart-Hledik, Jennifer C; Blazek, Katerina et al. (2017) Anatomically Standardized Maps Reveal Distinct Patterns of Cartilage Thickness With Increasing Severity of Medial Compartment Knee Osteoarthritis. J Orthop Res 35:2442-2451
Titchenal, Matthew R; Chu, Constance R; Erhart-Hledik, Jennifer C et al. (2017) Early Changes in Knee Center of Rotation During Walking After Anterior Cruciate Ligament Reconstruction Correlate With Later Changes in Patient-Reported Outcomes. Am J Sports Med 45:915-921
Erhart-Hledik, Jennifer C; Chu, Constance R; Asay, Jessica L et al. (2017) Gait mechanics 2 years after anterior cruciate ligament reconstruction are associated with longer-term changes in patient-reported outcomes. J Orthop Res 35:634-640
Favre, Julien; Erhart-Hledik, Jennifer C; Chehab, Eric F et al. (2016) General scheme to reduce the knee adduction moment by modifying a combination of gait variables. J Orthop Res 34:1547-56
Zabala, Michael E; Favre, Julien; Andriacchi, Thomas P (2015) Relationship Between Knee Mechanics and Time Since Injury in ACL-Deficient Knees Without Signs of Osteoarthritis. Am J Sports Med 43:1189-96
Andriacchi, Thomas P; Favre, Julien; Erhart-Hledik, J C et al. (2015) A systems view of risk factors for knee osteoarthritis reveals insights into the pathogenesis of the disease. Ann Biomed Eng 43:376-87
Bevill, S L; Boyer, K A; Andriacchi, T P (2014) The regional sensitivity of chondrocyte gene expression to coactive mechanical load and exogenous TNF-? stimuli. J Biomech Eng 136:091005
Favre, J; Erhart-Hledik, J C; Andriacchi, T P (2014) Age-related differences in sagittal-plane knee function at heel-strike of walking are increased in osteoarthritic patients. Osteoarthritis Cartilage 22:464-71
Scanlan, Sean F; Donahue, Joseph P; Andriacchi, Thomas P (2014) The in vivo relationship between anterior neutral tibial position and loss of knee extension after transtibial ACL reconstruction. Knee 21:74-9

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