ATOAC Research Highlight: UNC Exercise and Sport Science Knee Injury Research Group

Posttraumatic Osteoarthritis: Understanding the Biomechanical and Biochemical
Double Whammy

Researchers merging their expertise in movement mechanics and biochemical markers to learn more about the etiology of posttraumatic knee osteoarthritis following anterior cruciate ligament reconstruction

One in three people that have undergone an anterior cruciate ligament reconstruction develop posttraumatic knee osteoarthritis in the first 10 years following injury. To date, there is no clear pathophysiologic mechanisms that define why ACL reconstructed individuals develop knee osteoarthritis at such an accelerated rate. Some researchers and clinicians have hypothesized that the primary ACL injury and reconstructive surgery that cause damage to different tissues within the knee initiate an inflammatory cascade that ultimately leads to accelerated breakdown of articular cartilage and subchondral bone in the knee. Others have suggested that persistent abnormalities in how the knee is loaded during daily movements cause the chronic breakdown of articular cartilage and osteoarthritis development. Our recent approach has been to evaluate how both mechanical changes involved with knee loading and biochemical changes related to articular cartilage breakdown may interact to hasten the progression of knee osteoarthritis.

Our Knee Injury Research Group in the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill, has recently developed collaborations with researchers at Tufts Medical Center (Jeff Driban), Thurston Arthritis Research Center (Joanne Jordan) and the University of North Carolina Department of Orthopaedics (Jeff Spang) to evaluate both biomechanical and biochemical contributions to the development of posttraumatic knee osteoarthritis. We will be presenting four posters related to our initial findings at the 2015 OARSI World Congress on Osteoarthritis in April.*  As we continue to learn more about the mechanisms associated with the development of posttraumatic knee osteoarthritis, we believe it is critical to make athletic trainers aware of the pivotal role they must play in patient education, early detection and initial treatment of posttraumatic osteoarthritis following acute knee injury.  Future interventions that target either movement mechanics or joint metabolism may be best implemented early following knee injury by athletic trainers. Athletic trainers should play a crucial role in the continued follow-up care of injured patients, focusing on the maintenance of long-term joint health for these individuals following the assimilation back into normal physical activity.

*Related posters that will be presented at 2015 OARSI World Congress on Osteoarthritis in Seattle, Washington

Pietrosimone B, Blackburn JT, Harkey MS, Luc BA, Pamukoff DN, Lane AR, Hackney AC, Padua DA, Stanley LE, Mauntel T, Frank BA, Spang J, Jordan JM, Driban JB. Greater Peak Vertical Ground Reaction Force and Vertical Ground Reaction Force Loading Rate during Walking Gait are Associated with a Lower Serum Ratio of Collagen Turnover in Individuals with Anterior Cruciate Ligament Reconstruction.

Harkey MS, Luc BA, Frank B, Mauntel T, Stanley L, Lane A, Pamukoff D, Hackney AC, Blackburn JT, Padua DA, Spang JT, Jordan JM, Driban JB, Pietrosimone B. Frontal Plane Kinematics during Walking Gait Associate with Increased Serum Concentration of Aggrecan Breakdown, but not Type II Collagen Breakdown, in Patients Following Anterior Cruciate Ligament Reconstruction.

Luc BA, Harkey MS, Blackburn JT, Stanley LE, Pamukoff DN, Mauntel TC, Frank BA, Padua DA, Spang JT, Jordan JM, Driban JB, Pietrosimone B. Influence of Frontal Plane Knee Angle and Hip Strength on Medial Knee Joint Loading during Walking Gait in Individuals with Anterior Cruciate Ligament Reconstruction.

Blackburn JT, Pietrosimone BG, Frank BA, Harkey MS, Luc BA, Mauntel TC, Pamukoff DN, Stanley LE, Spang J, Jordan J. Kinetic gait adaptations following anterior cruciate ligament reconstruction: Implications for post-traumatic knee osteoarthritis.

UNC Exercise and Sport Science Knee Injury Research Group

Left to Right: FJ Goodwin, Troy Blackburn, Brittney Luc, Darin Padua, Matthew Harkey, Brian Pietrosimone, Barnett Frank, Laura Stanley, Tim Mauntel, Shiho Goto, Tony Hackney, Derek Pamukoff