Although most people associate osteoarthritis (OA) with aging, this degenerative disease is not limited to older adults. Young adults and athletes are susceptible, especially after suffering a knee injury. Research by Athletic Training Professor Timothy Tourville shows hope for preventing or reversing knee osteoarthritis following an anterior cruciate ligament (ACL) rupture.
“ACL injury is a significant trauma and we know that after people sustain an ACL tear they are more likely to suffer from osteoarthritis,” Tourville explained. “A 14- to 15-year old soccer player who tears an ACL could be looking at knee replacement at 35- to 40-years old to relieve OA. We may be able to slow or stop it.”
Dr. Tourville’s research focuses on the cellular- and molecular-level adaptations in skeletal muscle that occur during the onset and progression of OA post- trauma, and how identifying these biochemical and biomechanical changes can determine targets for therapeutic intervention.
Benchtop to Bedside
One of Tourville’s studies concentrates on young adults who sustained knee injuries through skiing, basketball and other sports. Their muscle tissue samples, joint fluid, blood and urine go to Tourville’s lab, where he and his research assistants use cutting-edge techniques, including musculoskeletal imaging technology, immunohistochemical staining and fluorescence microscopy to detect physical, chemical and molecular changes to muscle fibers and cartilage.
“We’re looking at biochemical markers at the cellular level,” he explained. “We can look at the infancy of an injury to detect early changes so that we can do something to prevent onset of osteoarthritis.”
Tourville’s team follows the patients after ACL repair surgery to monitor their recovery and identify muscle atrophy, neural changes and alteration of surrounding tissues.
“After surgery, a patient can’t do a strength test, but we can look at a muscle biopsy and see how strong it is. We can compare the injured knee to the uninjured one. We tease out one muscle fiber with a tweezer and put it in a machine with a calcium bath to see how much tension is produced. We can do a gait assessment with an infrared camera system to calculate the biomechanics of the knee and lower leg, to look at changes in how they walk and compare their two legs while they are moving,” he said. “The results have the potential to impact clinical care by informing the development of new interventions to specifically target the cellular and sub-cellular muscle adaptations that contribute to post-traumatic osteoarthritis following severe knee trauma.”
Interdisciplinary and Interprofessional
Tourville collaborates on additional research that focuses on injury prevention to decrease lower extremity injuries in high school athletics. He works closely with faculty colleagues in the UVM Larner College of Medicine and College of Engineering and Mathematical Sciences’ Biomedical Engineering and Mechanical Engineering programs on various studies and projects. His additional areas of expertise include the effectiveness of surgical techniques and rehabilitation following orthopedic injuries and physical activity as it relates to injury prevention, evaluation and rehabilitation.
He teaches courses about evidence-based practices in athletic training and the recognition and treatment of general medical conditions and systemic diseases, including asthma, diabetes and skin disorders.
“An athletic trainer is often the first person to evaluate and recognize a health issue. We work with physicians, nurses, physical therapists and cardiologists. It’s a multifaceted profession,” Tourville said.
This year, the National Athletic Trainers Association presented Tourville with an Athletic Training Service Award for his volunteer contributions to the athletic training profession. He has been actively involved in the Athletic Trainers’ Osteoarthritis Consortium, which works to raise awareness of osteoarthritis within sports medicine.
Committed to community service, Tourville collaborates with Vermont Adaptive to give athletic training students opportunities to work with physically and emotionally challenged youth at Bolton Valley ski resort and with military veterans. The veterans come to UVM to play sports and socialize with the students.
“It’s incredibly rewarding for the students to interact with the veterans, hear their stories and learn about their needs. We talk about chronic pain management of orthopedic injuries and the psychological effects of trauma. The students see health care disorders first hand,” Tourville said.
Tourville holds a secondary appointment as assistant professor in the McClure Musculoskeletal Research Center in the Department of Orthopaedics & Rehabilitation of The University of Vermont Larner College of Medicine. He has served as lecturer in the UVM College of Nursing and Health Sciences' Athletic Training Program and also as a clinical research specialist and project coordinator for the McClure Musculoskeletal Research Center.