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以及ACL重建移植物和/或对侧ACL失败的发生率，确定骨关节炎（OA）症状、运动功能、活动和一般健康状况的长期预后和潜在可修改的预测因素。我们的初始资助（R 01 AR 053684）允许我们招募超过2,300名患者，并对该队列进行2年和6年随访。在这两个时间点，我们已经能够获得至少85%的后续行动，使用验证的患者报告的结果问卷和93%通过电话随访。在本次竞争性修订中，将推进母基金最初三个目标中的两个，1）经确认的患者报告的运动功能、活动水平、一般健康状况和症状性OA结局，以及2）ACL移植物或对侧ACL失败。本次修订的目的是在母基金资助的最后1.5年（2014年4月-2015年8月）内，完成对另外一个无资金支持的MOON队列1251例ACL重建患者的6年随访（已完成86%的2年随访率）。这将使我们现有的样本量增加约50%，并使我们能够建立最全面的“个性化”模型，以解决半月板和关节软骨损伤和治疗（及其相互作用）对几个患者报告的结果和OA症状的详细贡献。此外，我们将是第一个对ACL移植物和对侧ACL失败进行复杂的多变量预测建模的人。纳入较长的6年时间间隔的额外变量尤其 对于确定OA的长期结局和症状以及同侧和对侧ACL撕裂的发生率非常重要。

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 symptoms of osteoarthritis (OA), sports function, activity and general health through validated patient- reported outcomes, and incidence of ACL reconstruction graft and/or contralateral ACL failures. Our initial grant (R01 AR053684) allowed us to enroll over 2,300 patients and obtain both 2 and 6 year follow-up on this cohort. At both time points, we have been able to obtain a minimum of 85% follow-up using validated patient-reported outcome questionnaires and 93% via phone follow-up. Two of the original three Aims from the parent grant will be advanced in this competitive revision, 1) validated patient-reported outcomes of sports function, activity level, general health, and symptomatic OA, and 2) ACL graft or contralateral ACL failures. The objective of this revision is to complete 6 year follow-up on an additional unfunded MOON cohort of 1251 ACL reconstructed patients (with an already completed 86% 2 year follow-up rate) in the last 1.5 years of the parent grant (4/2014 - 8/2015). This would increase our existing sample size by ~ 50%, and would enable us to build the most comprehensive "personalized" models to address detailed contributions of meniscus and articular cartilage injury and treatment (and their interactions) to several patient reported outcomes and OA symptoms. Furthermore, we would be the first to perform complex multivariable predictive modeling of ACL graft and contralateral ACL failure. The additional variables incorporated into longer 6 year time interval is particularly important for establishing the longer-term outcomes and symptoms of OA and incidence of both ipsilateral and contralateral ACL tears.