Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

描述（由申请方提供）：前交叉韧带（ACL）损伤会对积极的生活方式造成威胁，并使患者面临早期骨关节炎的风险。ACL重建通常由个人选择，以允许恢复他们以前的工作和体育活动。初次ACL重建的结果通常在恢复功能稳定性方面很好，但患者的长期结局仍然未知。多中心骨科结局网络（MOON）是一个成熟的联盟，旨在招募和纵向随访ACL重建患者的人群队列，以确定ACL重建长期结局的可修改预测因子（或风险因素），从而建立临床重要结局的患者特异性预测模型。本前瞻性多中心ACL重建队列研究的目的是通过经验证的患者报告结局、骨关节炎（OA）症状和体征以及ACL重建移植物和/或对侧ACL失败的发生率，确定运动功能、活动和总体健康的长期预后和潜在可修改的预测因素。在过去的资助周期中，我们招募了2,000多名患者，并使用经验证的患者报告结局问卷对85%（1989/2340）的队列完成了两年随访，93%（2176/2340）通过电话随访完成。此外，125名ACL重建患者的嵌套队列在2年后返回现场进行全面的临床评估、放射学测量，沿着完成患者报告的评估。本次竞争性更新的目的是使用相同的经确认结局测量值以及临床移植物和/或对侧ACL失效的发生率，在6年时纵向随访该捕获队列。此外，我们计划扩大现场嵌套队列的入组人数，以确定临床评估与OA症状和体征的预测因子和相关性以及经验证的结局（在运动功能、活动和一般健康方面）。该基金主要关注6年随访时ACL重建结果的预测因素。这将通过三个具体目标来实现。目标1将确定恢复运动功能、体力活动水平和患者报告的生活质量的独立预测因素。目标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预测因子。目标3将确定ACL重建后对患者进行额外手术的发生率。一旦确定了好或坏结局的预测因素，外科医生就可以接受潜在的可修改变量的教育，以改善结局。 公共卫生相关性：这项多中心、多外科医生前瞻性研究将允许确定ACL重建术后不良结局的临床预测因素。一旦确定了良好和不良结局的预测因素，外科医生和患者就可以了解改善患者结局的潜在可修改变量。

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.