Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

 描述(由申请人提供)：前十字韧带(ACL)损伤导致对积极生活方式的威胁，并使患者面临早期骨关节炎的风险。重建前交叉韧带通常是由个人选择的，以允许恢复到他们以前的工作和体育活动。初步前交叉韧带重建的结果总体上在恢复功能稳定性方面是良好的，但患者的长期结果仍不清楚。多中心矫形外科结果网络(MON)是一个建立起来的联盟，旨在招募和纵向跟踪多中心前交叉韧带重建患者，以确定前交叉韧带重建长期结果的可修改预测因素(或风险因素)，以便建立具有临床重要性的患者特有的预测模型。这一前瞻性多中心前交叉韧带重建队列的目的是通过验证患者报告的结果，以及前交叉韧带重建移植物和/或对侧前交叉韧带失败的发生率，确定骨关节炎(OA)、运动功能、活动和一般健康症状的长期预后和潜在的可修改的预测因子。我们之前的资助(R01 AR053684)使我们能够招募3547名患者，并获得对该队列的2年和6年随访。在这两个时间点，我们都能够通过有效的患者报告结果问卷获得至少84%的随访，通过电话随访获得93%的随访。此外，一组嵌套队列或317名重建前交叉韧带的患者在两年后返回现场进行全面的临床评估、专门的放射学测量，以及完成患者报告的结果。这笔赠款的目标是纵向跟踪 这两个队列在10年内使用相同的验证结果测量，并跟踪临床移植物和/或对侧前交叉韧带失败的发生率。此外，嵌套的队列将 帮助确定临床评估与骨性关节炎的症状和体征以及确认的结果(就运动功能、活动和一般健康而言)之间的预测因素和相关性。这项资助侧重于预测10年后前交叉韧带重建结果的预测因素，并将通过三个具体目标来实现。目标1将确定风险因素或 恢复运动功能、体力活动水平和患者报告的生活质量的预测因素。具体目标2将确定在前交叉韧带重建时测量的与术后10年早期骨关节炎症状相关的危险因素或预测因素。具体目标3将确定前交叉韧带重建后患者再次手术和移植物失败的发生率。一旦确定了更糟糕结果的风险因素或预测因素，外科医生就可以接受潜在的可修改变量的培训，以改善结果。

 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.