ACL Study

Project: Biomechanics, Biomarkers, and MRI: A Three-Pronged Approach to Predicting Anterior Cruciate Ligament (ACL) Rupture




ACL rupture is a commonly sustained musculoskeletal injury with a conservative estimate of approximately 80,000 occurrences in the United States each year. This injury is associated with a number of negative consequences which include: pain, joint instability, and inability to return to previously conducted levels of athletic participation, whether for competition, exercise, or leisure. Perhaps the most detrimental outcome of this injury, however, is the initiation and development of early onset osteoarthritis in the affected joint. Current estimates provide that the ACL-injured knee will develop osteoarthritis within 5-20 years after injury, “ageing” the knee by approximately 30 years. Given that ACL rupture is most commonly experienced by individuals 15-25 years of age, a substantial number of young adults in their 20’s and 30’s are experiencing the initiation of knee osteoarthritis, where what follows is a pain, swelling, stiffness, and often times total knee replacement surgery. 

Individuals who sustain this injury will often elect to undergo reconstructive surgery where a replacement ACL, or a graft, is inserted and secured within the knee to increase the kinematic stability of the joint. This is especially common in athletes as the desire to return to sport is high. It has been estimated that there are approximately 50,000 ACL reconstructions performed in the United States each year, resulting in a financial impact of just under a billion dollars ($850,000,000). Unfortunately, the risk of early-onset knee osteoarthritis is in no way mitigated by ACL reconstructive surgery; the risk remains the same. Moreover, it is likely that costs associated with long-term health care for osteoarthritis are much higher than that of reconstructive surgery.

The proposed study is a prospective cohort design that will utilise three avenues of investigation to assess ACL injury susceptibility in especially at-risk athletes at Auburn University. Specifically, the question proposed by the current study is: Is there a combination of biomechanics, biochemistry, and MRI-detectible ACL biological composition which can cumulatively and accurately predict ACL injury risk? The long-term goals are three-fold. 1. determine a complete ACL injury risk profile by evaluating biomechanics, biochemistry, and ACL biological composition, 2. develop a useful screening protocol for at-risk athletes for the purpose of implementing a prevention/training regimen to reduce the overall risk of ACL injury, and 3. better characterize the success of ACL reconstructive surgery for restored biomechanics and joint health (i.e. osteoarthritis initiation) following injury. 

The supporting objectives for these long-term goals are: 
Objective 1: Determine if there is a combination of preinjury blood serum biomarkers of collagen turnover, lower-limb biomechanics, and ACL biological composition measured via MRI that will predict subsequent risk of ACL injury. 
Objective 2: Determine if there is an association between preinjury blood serum biomarkers of collagen turnover and lower-limb biomechanics.  
Objective 3: Determine if there is an association between preinjury blood serum biomarkers of collagen turnover and ACL biological composition measured via MRI.

The results of the proposed study have the potential to bring significant long-term and broader impacts. These include an overall reduction in the number of ACL injuries due to an effective screening protocol for at-risk athletes followed by a prevention training program. This impact will also directly reduce the incidence of early onset osteoarthritis, which is a direct result of ACL injury. Other direct benefits of an advancement in injury prevention is a decrease in the potential for loss of entire seasons of sports participation for athletes, a reduction in financial burden on the health care system, decreased long-term disability and an overall sustainment of quality of life for those not able to otherwise avoid injury.

Last Updated: 6/26/17 3:22 PM