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重建患者的多中心队列，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。我们之前的赠款（R 01 AR 053684）使我们能够招募3，547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84%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。此外，一个嵌套队列或317名ACL重建患者在2年后返回现场进行全面的临床评估、专门的放射学测量，沿着完成患者报告的结局。该补助金的目标是纵向跟踪 这两个队列在10年时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。此外，嵌套队列将 有助于确定临床评估与OA症状和体征的预测因子和相关性，以及经验证的结果（在运动功能、活动和一般健康方面）。这项资助的重点是10年随访时ACL重建结果的预测因素，并将通过三个特定目标来实现。目标1将确定风险因素或 运动功能恢复、体力活动水平和患者报告的LFE质量的预测因子。具体目标2将确定ACL重建时测量的与术后10年早期骨关节炎症状相关的风险因素或预测因素。具体目标3将确定ACL重建后对患者进行的额外手术和移植物失败的发生率。一旦确定了风险因素或更差结局的预测因素，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。

 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 multicenter 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 previous grants (R01 AR053684) have allowed us to enroll 3,547 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 84% follow-up using validated patient-reported outcome questionnaires and 93% via phone follow-up. In addition, a nested cohort or 317 ACL reconstructed patients returned onsite after 2 years for a comprehensive clinical assessment, specialized radiologic measurements, along with completing their patient-reported outcomes. The objective of this grant is to longitudinally follow these two cohorts at 10 years utilizing the same validated outcome measurements as well as following incidence of clinical graft and/or contralateral ACL failure. Further, nested cohort will help 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 10 year follow-up, and will be accomplished by three Specific Aims. Aim 1 will identify the risk factors or predictors of return to sports function, physical activity level, and patient-reported quality of lfe. Specific Aim 2 will identify those risk factors or predictors measured at the time of the ACL reconstruction associated with symptoms of early osteoarthritis at 10 years post-surgery. Specific Aim 3 will identify incidence of additional surgery and graft failure performed on patient following ACL reconstruction. Once the risk factors or predictors for worse outcomes are identified, surgeons can be educated in potential modifiable variables to improve the outcome.