Revision ACL Reconstructions: A Comparative Effectiveness Treatment Study

修正 ACL 重建：比较疗效治疗研究

• 批准号: 8515936
• 负责人: Rick W Wright
• 金额: $ 64.73万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8515936
• 关键词: Address; Adopted; Affect; Allografting; American; Anterior Cruciate Ligament; Articular Range of Motion; Autologous Transplantation; Braces-Orthopedic appliances; Clinical; Clinical Trials; Cohort Analysis; Cohort Studies; Defect; Degenerative polyarthritis; Development; Enrollment; Evidence based practice; Failure; Future; Goals; Grant; Incidence; Individual; Inferior; Injury; Institution; Knee; Knee Osteoarthritis; Lead; Lesion; Location; Measures; Mind; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Pain; Pathology; Patients; Physical activity; Physicians; Postoperative Period; Prevalence; Private Practice; Prospective Studies; Quality of life; Recreation; Rehabilitation therapy; Relative (related person); Reliance; Repeat Surgery; Reporting; Research Design; Risk; Risk Factors; Rupture; Sample Size; Societies; Sports; Sports Medicine; Surgeon; Surgical incisions; Swelling; Symptoms; Techniques; Time; Weight-Bearing state; anterior cruciate ligament reconstruction; base; bone; comparative effectiveness; follow-up; graft failure; improved; prospective; reconstruction; success

DESCRIPTION (provided by applicant): Revision anterior cruciate ligament (ACL) reconstruction represents an infrequent but clinically important challenge in orthopaedic practice. Technical issues require specific revision techniques to address complications such as retained hardware, bone tunnel defects, and incorrect tunnel placement. Moreover, it is commonly reported that the results of revision surgery remain inferior to primary 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 multi-center study is necessary to accumulate enough subjects over a reasonable time frame to allow for multivariable analyses. With this in mind, the Multi-center ACL Revision Study (MARS) group was established as an 87 surgeon multi-center group 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). The group has been enrolling revision ACL reconstruction patients for over three years and has accumulated greater than 800 patients. This grant uses a prospective cohort study design and focuses on the modifiable predictors for ACL revision outcome at two-year follow-up. The overall goal is to elucidate the factors responsible for success or failure of ACL revision. We hypothesize that modifiable independent variables exist at the time of revision ACL reconstruction that will predict revision ACL reconstruction outcomes. This will be accomplished by focusing on four Specific Aims. Specific Aim 1 will determine if graft choice predicts incidence of graft rerupture, reoperation, return to sports function and activity level 2 years post-surgery. Specific Aim 2 will determine if modifiable surgical factors influence graft rerupture rates and return to sports function. Specific Aim 3 will determine if both prevalence and/or degree of meniscal and chondral damage measured at the time of the revision ACL reconstruction predicts activity level, return to sports function, and pain and swelling symptoms 2 years post-surgery. Specific Aim 4 is an exploratory aim, which determines if various rehabilitation factors influence the incidence of graft rerupture or return to sports activity 2 years following revision ACL surgery. The results of this study will drive the field of Orthopaedics Sports Medicine, in that it will guide practitioners to most appropriately choose the graft for reconstruction, modify surgical approaches and techniques, and manage meniscal and chondral injuries in a way to provide optimal outcome.

描述（由申请人提供）：前十字韧带（ACL）重建修复是骨科实践中罕见但具有临床意义的挑战。技术问题需要特定的修复技术来解决并发症，例如保留的硬件、骨隧道缺陷和不正确的隧道放置。此外，据普遍报道，修复手术的结果仍然不如初次重建。这些较差的结果包括较差的患者结果、膝关节松弛增加、移植物失败率较高、半月板变性和软骨损伤。已经提出了结果率较差的许多原因，包括隧道位置受损、初次重建期间未经治疗的病理以及更多地依赖同种异体移植进行修复。为了评估这些因素和其他因素对结果的影响，必须识别并前瞻性跟踪大量正在接受修复的患者。然而，由于任何一个中心进行 ACL 重建修复的频率相对较低，因此有必要进行一项大型多中心研究，以便在合理的时间范围内积累足够的受试者，以便进行多变量分析。考虑到这一点，多中心 ACL 修复研究 (MARS) 小组成立，由 87​​ 名外科医生组成的多中心小组，对修复 ACL 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师组成的混合团体，并得到了美国运动医学骨科协会 (AOSSM) 的支持和认可。该小组入组ACL修复重建患者已有三年多的时间，累计患者超过800例。该资助采用前瞻性队列研究设计，重点关注两年随访时 ACL 翻修结果的可修改预测因素。总体目标是阐明 ACL 修复成功或失败的因素。我们假设在 ACL 重建修复时存在可修改的自变量，这将预测 ACL 重建重建的结果。这将通过关注四个具体目标来实现。具体目标 1 将确定移植物选择是否可以预测移植物再破裂、再次手术、术后 2 年恢复运动功能和活动水平的发生率。具体目标 2 将确定可改变的手术因素是否会影响移植物的再破裂率和运动功能的恢复。具体目标 3 将确定在 ACL 重建修复时测量的半月板和软骨损伤的患病率和/或程度是否可以预测术后 2 年的活动水平、运动功能的恢复以及疼痛和肿胀症状。具体目标 4 是一个探索性目标，它确定各种康复因素是否会影响 ACL 修复手术后 2 年内移植物再破裂或恢复体育活动的发生率。这项研究的结果将推动骨科运动医学领域的发展，因为它将指导医生最合适地选择用于重建的移植物，修改手术方法和技术，并以提供最佳结果的方式处理半月板和软骨损伤。