Revision ACL Reconstruction: A Comparative Effectiveness Treatment Study

项目摘要/摘要 前交叉韧带翻修重建术是一种不常见但临床上很重要的方法 整形外科实践中的挑战。据普遍报道，翻修手术的结果仍然 不如主ACL重建。这些较差的结果包括基于患者的较差结果， 膝关节松弛增加，移植物失败率增加，半月板变性和软骨损伤。一批 预后较差的原因已被提出，包括隧道位置受损、病理 在初次重建过程中没有得到治疗，更多地依赖同种异体移植物进行修复。为了 评估这些因素和其他因素对结果的贡献，大量患者 必须确定正在进行的修订，并进行前瞻性的跟踪。然而，由于相对的原因 在任何一个中心，翻修前交叉韧带重建的频率很低，有必要进行大型多中心研究，以 在合理的时间范围内积累足够的研究对象，以便进行多变量分析。有了这一点 记住，多中心前交叉韧带修订研究(MARS)小组是作为83名外科医生建立的多中心 联合对翻修前交叉韧带重建进行前瞻性纵向队列分析。这是一个 由学术和私人执业医生组成的混合团体，并已得到 美国运动医学骨科学会(AOSSM) 我们之前的资助(5R01 AR060846)允许我们招募1200多名患者并获得短期(2- )和中期(6年)的后续行动。这项研究设计包括一组纵向前瞻性队列 我们对他们进行了基线、2年和6年的随访。在两个后续时间点，我们都能够 使用经过验证的患者报告结果问卷获得至少80%的随访率，通过 电话追踪。这次赠款续期的目标是评估10年来的进展 修复前交叉韧带重建后的结果，并确定当时的初始因素 翻修手术可以影响和预测疾病的进展。这项提议的新功能是 将PROMIS患者报告的结果添加到整个队列中，以及添加嵌套的 队列，为此，我们的目标是带回400名登记的患者进行现场标准化放射学检查 和体检措施。此续订申请的重点是描述10年期自然 这一独特的数据集的历史，由3种互补的方法量化：患者报告的结果， 放射学和体格检查措施。这一更新将建立在第2和第6中演示的结果的基础上 并确定这些在长期的后续行动中是否继续适用。

PROJECT SUMMARY/ ABSTRACT Revision anterior cruciate ligament (ACL) reconstruction represents an infrequent but clinically important challenge in orthopaedic practice. It is commonly reported that the results of revision surgery remain inferior to primary ACL reconstructions. These poorer outcomes include worse patient based outcomes, increased knee laxity, higher graft failure rate, meniscal degeneration, and chondral lesions. A number of reasons for the poorer outcome rate have been proposed, including compromised tunnel location, pathology untreated during the primary reconstruction, and greater reliance on allografts for revisions. In order to evaluate the contributions of these and other factors to outcome, large numbers of patients who are undergoing revisions must be identified and followed prospectively. However, due to the relative infrequency of revision ACL reconstructions in any one center, a large multicenter study is necessary to accumulate enough subjects over a reasonable time frame to allow for multivariable analyses. With this in mind, the Multicenter ACL Revision Study (MARS) group was established as an 83 surgeon multicenter consortium to perform a prospective longitudinal cohort analysis of revision ACL reconstruction. This is a mixed group of academic and private practice physicians and has been supported and endorsed by the American Orthopedic Society for Sports Medicine (AOSSM). Our previous grant (5R01 AR060846) has allowed us to enroll over 1,200 patients and obtain both short (2- year) and mid-term (6-year) follow-up. This study design involves a longitudinal prospective cohort for whom we have baseline, 2-year and 6-year follow-up on. At both follow-up time points, we have been able to obtain a minimum of 80% follow-up using validated patient-reported outcome questionnaires and 92% via phone follow-up. The objective of this grant renewal is to assess the 10-year progression of outcomes following revision ACL reconstruction, and to determine how the initial factors at the time of revision surgery may influence and predict disease progression. New to this proposal is the addition of PROMIS patient reported outcomes to the entire cohort, as well as the addition of a nested cohort, for which we aim to bring back 400 of these enrolled patients for onsite standardized radiographs and physical exam measures. The focus of this renewal application is to characterize the 10-year natural history of this unique dataset, quantified by 3 complementary methodologies: patient-reported outcomes, radiologic and physical exam measures. This renewal will build upon the findings demonstrated at 2 and 6 years and determine if these continue to hold true at long-term follow-up.