A Multi-center Cohort Study of ACL Reconstruction Outcomes

应聘者：沃伦·R·邓恩，医学博士，公共卫生硕士，范德比尔特大学整形外科助理教授，二级任命为卫生服务研究中心医学与公共卫生系助理教授。他在运动医学和肩部服务特别外科医院完成了美国整形外科学会/矫形外科研究和教育基金会卫生服务研究奖学金。在这份K23申请中，他提出了一个全面的五年职业发展计划，其中包括临床流行病学、生物统计学、临床试验设计方面的高级课程和培训，并进行一个指导性研究项目，调查前十字韧带(ACL)重建后的结果，以实现成为一名独立外科科学家的目标。项目理念：体育活动和健身是2010年健康人活动的重点领域之一，运动参与度不断提高。与之一致的是，前交叉韧带损伤和后续前交叉韧带重建的数量正在增加，估计每年的成本为20亿美元。现有证据表明，前交叉韧带重建术在两年内成功地恢复了术前功能，但这些研究利用了未经验证的结果测量，往往缺乏长期随访，并留下了不良结果、移植物失败和其他外科手术的危险因素不明确的因素。设计：将使用一项涉及已建立的多中心矫形外科结果网络(MOUNE)的多中心观察性队列研究。建议的指导性研究的目的是检验这样一种假设，即在重建前交叉韧带时记录的客观预测因子与有效的结果器械和关节炎(目标1)、额外的外科手术和移植物失败(目标2)相关。范德比尔特是一个强大的学术环境，能够提供必要的教育、培训和指导，使邓恩博士成为一名独立的、以患者为导向的临床医生科学家。前交叉韧带是人体内最常见的损伤韧带，这一重要的稳定器的破坏会导致膝关节的进一步损伤。前交叉韧带重建可以恢复膝关节的稳定性，然而，目前还不清楚手术是否能预防以后的膝关节关节炎。确定与生活质量和关节炎相关的因素至关重要，因为关节炎，特别是年轻人的关节炎，是一个主要的公共卫生问题。

DESCRIPTION (provided by applicant): Candidate: Warren R. Dunn, MD, MPH, Assistant Professor of Orthopaedics at Vanderbilt University with a secondary appointment as Assistant Professor in the Department of Medicine & Public Health at the Center for Health Services Research. He completed the American Academy of Orthopaedic Surgeons / Orthopaedic Research and Education Foundation Health Services Research Fellowship at the Hospital for Special Surgery on the Sports Medicine and Shoulder Service. In this K23 application he proposes a comprehensive five-year career development plan that includes advanced coursework and training in clinical epidemiology, biostatistics, clinical trial design, and to conduct a mentored research project investigating outcomes after anterior cruciate ligament (ACL) reconstruction in order to achieve the goal of becoming an independent surgeon scientist. Project Rationale: Physical activity and fitness is one of the focus areas of Healthy People 2010, and sports participation is increasing. In accord, the number of ACL injuries and subsequent ACL reconstructions is increasing at an estimated annual cost of 2 billion dollars. Available evidence shows that ACL reconstructions have been successful in restoring preoperative function at two years, but these studies have utilized non-validated outcome measures, often lack long-term follow-up, and have left risk factors for poor outcome, graft failure, and additional surgical procedures ill defined. Design: A multi-center observational cohort study involving an established Multi-center Orthopaedic Outcomes Network (MOON) will be utilized. The purpose of the proposed mentored research is to test the hypothesis that objective predictors recorded at the time of ACL reconstruction are associated with validated outcome instruments and arthritis (Aim 1), and additional surgical procedures and graft failure (Aim 2). Vanderbilt is a robust academic environment capable of providing the education, training, and mentorship necessary to enable Dr. Dunn to become an independent patient-oriented clinician scientist. The ACL is the most frequently injured ligament in the body, and disruption of this important stabilizer leads to giving way episodes that cause further injury to the knee. ACL reconstruction restores stability to the knee, however, it is unclear if surgery prevents later arthritis of the knee. Identifying factors associated with quality of life and arthritis is critical because arthritis, particularly in young adults, is a major public health concern.