Association Between Physical Activity, Cumulative Loading, and Post Traumatic Knee Osteoarthritis Symptoms and Pathology

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  • Davis-Wilson, Hope C
    • School of Medicine, Department of Allied Health Sciences, Curriculum in Human Movement Science
Abstract
  • Context: Alterations in biomechanical loading during walking in individuals with an anterior cruciate ligament reconstruction (ACLR) are hypothesized to lead to the development of post-traumatic knee osteoarthritis (PTOA). Appropriate biomechanical loading is necessary for maintaining ideal articular cartilage health, yet the optimal amount of joint loading to mitigate negative joint tissue changes following ACLR is unknown. Peak vertical ground reaction force (vGRF) during a single step associates with biomarkers of joint tissue metabolism, femoral cartilage composition, and patient reported outcome (PROs) following ACLR. However, it remains unknown how the frequency of daily steps, the intensity of physical activity or cumulative loading (i.e. the product of biomechanical loading during a single step [measured using peak vGRF] and daily steps), associates with measures of PROs, change in serum cartilage oligomeric matrix protein (COMP), change in femoral cartilage cross-sectional area (CSA) measured with ultrasound, resting serum matrix metalloproteinase-3 (MMP-3), resting COMP, and T1rho magnetic resonance imaging (MRI) relaxation times following ACLR. Objective: To determine the associations between physical activity, cumulative loading, and PTOA symptoms and pathology following ACLR. Participants: Individuals who underwent a primary unilateral ACLR. Methodology: PROs, demographics, and surgical information was collected. Daily steps and time in moderate to vigorous physical activity (MVPA) were objectively measured using an accelerometer, which participants wore for seven days. Cumulative loading was calculated as the product of daily steps and vGRF, measured using a force plate located in the laboratory. CSA of femoral cartilage using ultrasound and biochemical markers of serum COMP were collected both prior to and immediately following a 3000-step loading protocol in the laboratory. Biochemical markers of serum cartilage oligomeric matrix protein (COMP), serum matrix metalloproteinase-3 (MMP-3) and T1rho magnetic resonance imaging (MRI) relaxation times, a marker of proteoglycan density, of weight bearing regions of femoral cartilage in the involved limb were collected in a resting state. Main outcome measures: Separate univariate linear regression analyses were conducted to determine the unique change in R2 (∆R2) between the dependent variable and independent variable after accounting for covariates. For the primary aim, the dependent variables were daily steps, MVPA, and cumulative loading and the independent variables were PROs. For the second and third aims, independent variables were daily steps, MVPA, and cumulative loading. The dependent variables for the second aim were change in COMP and change in CSA of femoral cartilage. The dependent variables for the third aim were COMP, MMP-3, and T1rho MRI relaxation times in weight bearing regions of femoral cartilage. Results: Daily steps, MVPA, and cumulative loading did not associate with PROs or change in COMP and change in CSA following a standardized walking protocol. Greater time in MVPA associated with greater MMP-3, indicative of greater cartilage breakdown, and greater T1rho MRI relaxation times, indicative of lesser proteoglycan content. Conclusions: Excessive time in MVPA may associate with biomarkers of cartilage breakdown and proteoglycan depletion. The results of the current study suggest the need for longitudinal studies that evaluate physical activity and cumulative loading in individuals throughout the ACLR recovery process.
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Advisor
  • Pietrosimone, Brian
  • Blackburn, J Troy
  • Hackney, Anthony C
  • Franz, Jason R
  • Thoma, Louise M
  • Longobardi, Lara
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020
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