Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

描述（由申请人提供）：前交叉韧带（ACL）损伤会威胁到积极的生活方式，并使患者面临早期骨关节炎的风险。ACL重建通常是由个人选择的，以允许他们恢复以前的工作和体育活动。原发性ACL重建的结果通常很好地恢复了功能稳定性，但患者的长期预后尚不清楚。多中心骨科预后网络（MOON）是一个已建立的联盟，旨在招募和纵向跟踪ACL重建患者的人群队列，以确定ACL重建长期结果的可修改预测因素（或危险因素），从而建立临床重要结果的患者特异性预测模型。本前瞻性ACL重建多中心队列研究的目的是通过验证患者报告的结果、骨关节炎（OA）的症状和体征、ACL重建移植物和/或对侧ACL失败的发生率，确定长期预后和运动功能、活动和一般健康的潜在可改变的预测因素。在过去的资助周期中，我们招募了2000多名患者，并对85%（1989/2340）的患者进行了为期两年的随访，其中93%（2176/2340）通过电话随访。此外，一组125例ACL重建患者在2年后返回现场进行全面的临床评估、放射学测量，并完成患者报告的评估。这项竞争性更新的目的是利用相同的有效结果测量，以及临床移植物和/或对侧ACL失效的发生率，对该捕获的队列进行6年的纵向随访。此外，我们计划扩大现场嵌套队列的入组人数，以确定OA的症状和体征以及经验证的结果（运动功能、活动和一般健康）的临床评估的预测因素和相关性。这项资助的重点是预测前交叉韧带重建结果的6年随访。这将通过三个具体目标来实现。目的1将确定恢复运动功能、身体活动水平和患者报告的生活质量的独立预测因素。目的2将确定在ACL重建时测量的与术后6年早期骨关节炎症状相关的独立可修改的预测因子。目的3将确定ACL重建后患者进行额外手术的发生率。一旦确定了预后好坏的预测因素，外科医生就可以了解潜在的可修改变量，以改善预后。

DESCRIPTION (provided by applicant): Injury to the anterior cruciate ligament (ACL) results in a threat to an active lifestyle and exposes the patient to risk of early osteoarthritis. ACL reconstruction is typically chosen by individuals to allow a return to their previous work and sports activities. The results of primary ACL reconstruction have in general been good at restoring functional stability, but patients' long-term outcome remains unknown. The Multicenter Orthopaedic Outcomes Network (MOON) is an established consortium designed to enroll and longitudinally follow a population cohort of ACL reconstructed patients to determine the modifiable predictors (or risk factors) of long-term outcomes of ACL reconstruction in order to establish patient-specific predictive models of clinically important outcomes. The objective of this prospective multicenter cohort of ACL reconstructions is to identify both the long-term prognosis and the potentially modifiable predictors of sports function, activity and general health through validated patient-reported outcomes, symptoms and signs of osteoarthritis (OA), and incidence of ACL reconstruction graft and/or contralateral ACL failures. During the past funding cycle we have enrolled over 2,000 patients and have completed two year follow-up on 85% (1989/2340) of our cohort using validated patient-reported outcome questionnaires and 93% (2176/2340) via phone follow-up. In addition, a nested cohort of 125 ACL reconstructed patients returned onsite after 2 years for a comprehensive clinical assessment, radiologic measurements, along with completing their patient-reported assessment. The objective of this competitive renewal is to longitudinally follow this captured cohort at six years utilizing the same validated outcome measurements as well as following incidence of clinical graft and/or contralateral ACL failure. Further, we plan to expand enrollment in the onsite nested cohort to determine the predictors of and the correlates from clinical assessment with both the symptoms and signs of OA and validated outcomes (in terms of sports function, activity, and general health). This grant focuses on the predictors for ACL reconstruction outcome at six-year follow-up. This will be accomplished by three Specific Aims. Aim 1 will identify the independent predictors of return to sports function, physical activity level, and patient-reported quality of life. Aim 2 will identify those independent modifiable predictors measured at the time of the ACL reconstruction associated with symptoms of early osteoarthritis at 6 years post-surgery. Aim 3 will identify incidence of additional surgery performed on patients following ACL reconstruction. Once the predictors for good or bad outcomes are identified, surgeons can be educated in potential modifiable variables to improve the outcome. PUBLIC HEALTH RELEVANCE: This multicenter, multi-surgeon prospective study will allow determination of the clinical predictors of inferior outcomes following ACL reconstruction. Once the predictors for good and poor outcomes are identified, surgeons and patients can be educated to the potential modifiable variables that improve patient's outcomes.