Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

描述(申请人提供)：Tofler估计，每年有2000万儿童和青少年参加有组织的运动，前十字韧带(ACL)断裂是影响经常参加体育活动的男性和女性最常见的肌肉骨骼损伤之一。据估计，每年进行200,000次前交叉韧带重建(ACLR)，作为护理的标准，其依据是有证据表明器械松弛得到改善，恢复运动的愿望，以及未来膝关节损伤的减少。9这些前交叉韧带损伤对受伤者的生活质量、骨关节炎风险和长期残疾都有直接和长期的影响。尽管一些研究已经注意到，在前交叉韧带损伤和前交叉韧带损伤后，50%的膝关节由于损伤后关节炎而导致严重的长期残疾，但还没有研究确定预测关节炎体征和症状的发生率和时机的因素，或者这些因素对患者相关生活质量的影响。此外，还没有研究考察各种因素，包括术后活动和其他术后干预措施对患者相关生活质量、骨关节炎和ACLR术后复发损伤或手术的影响。我们已经建立了多中心矫形外科预后网络(MOUNE)，这是一项针对2362名ACLR患者(并不断纳入)的前瞻性队列研究，其中我们收集了详细的患者和损伤特征，以及ACLR时半月板和关节软骨损伤的临床决策。我们建议在ACLR后对这一已建立的队列进行为期两年的随访，使用9个建议的独立危险因素：生活质量(AIM1)、骨性关节炎(AIM2)的症状和体征以及复发性韧带损伤和手术(AIM3)。建议的独立危险因素包括患者的特征(年龄、性别、体重指数、活动水平、临床膝关节对齐)和他们的损伤(受伤时听到的“POP”、并发的半月板、关节软骨和副韧带损伤)，以及对并发的半月板和关节软骨损伤的治疗决定。这些面向患者的工具包括：1)膝关节损伤和骨关节炎结果评分(KOOS)，2)安大略省西部和麦克马斯特大学关节炎指数(WOMAC)，3)简表36(SF-36)，以及4)国际和膝关节文件委员会(IKDC)问卷。对于骨性关节炎的征兆，将获得一张专门的站立X光片。这项研究将是对接受ACLR的男性和女性进行的最大规模的前瞻性队列研究，旨在确定三种与临床相关的不良结局的风险因素。这项研究的结果将提高我们管理和咨询患者预后的能力，指导对关节内损伤和未来患者活动的决策，以及为未来的实验试验确定可修改的独立风险因素的可能性，从而促进科学知识的发展。

DESCRIPTION (provided by applicant): Tofler estimates that 20 million children and adolescents participate in organized sports annually with disruption of the anterior cruciate ligament (ACL) are among the most frequent musculoskeletal injuries affecting physically active men and women. An estimated 200,000 ACL reconstructions (ACLR) are performed annually as the standard of care based on evidence for improved instrumented laxity, the desire to return to sports play, and evidence for a reduction in future knee injuries.9 These ACL injuries have both immediate and long-term implications for an injured person's quality of life, their risk for osteoarthritis, and long-term disability. Although several studies have noted significant long-term disability due to post injury arthritis in 50% of the knees following ACL injury and ACLR, no studies have determined the factors that predict the incidence and timing of signs and symptoms of arthritis, nor the effect that such factors have on patient-related quality-of-life. In addition, no studies have examined the role that various factors, including post-surgical activity and other post-surgical interventions might have on patient-related quality-of-life, osteoarthritis and recurrent injury or surgery following ACLR. We have established the Multicenter Orthopaedic Outcome Network (MOON), which is a prospective cohort study of 2,362 ACLR patients (and with continual enrollment), in which we've collected detailed patient and injury characteristics, as well as the clinical decisions on meniscal and articular cartilage injuries sustained at the time of ACLR. We propose to conduct a two-year follow-up of this established cohort after their ACLR using nine proposed independent risk factors for quality-of-life (AIM 1), symptoms and signs of OA (AIM 2), and recurrent ligament injury and surgery (AIM 3). The proposed independent risk factors include characteristics of the patients (age, gender, BMI, activity level, clinical knee alignment) and their injuries ("pop" heard at time of injury, concurrent meniscal, articular cartilage, and collateral ligament injuries), and treatment decisions made on concurrent meniscus and articular cartilage injuries. These patient-oriented instruments include the, 1) Knee injury and Osteoarthritis Outcome Score (KOOS), 2) the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 3) the Short Form 36 (SF-36), and 4) the International and Knee Documentation Committee (IKDC) questionnaires. For signs of OA a specialized standing radiograph will be obtained. This study will be the largest prospective cohort study of men and women undergoing ACLR that seeks to identify risk factors for three clinically relevant poor outcomes. Results from this study will advance scientific knowledge by improving our ability to manage and counsel patients with regard to their prognosis, guide decision for intraarticular injuries and future patient activity as well as the potential to identify modifiable independent risk factors for future experimental trials.