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)是一个已建立的联盟，旨在招募和纵向跟踪一组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的预测因子(或危险因素)，以便建立临床上重要结果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。我们最初的资助(R01 AR053684)允许我们招募2300多名患者，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85%的随访，通过电话随访获得93%的随访。来自父母拨款的最初三个目标中的两个将在这次竞争性修订中得到推进，1)经患者报告的运动功能、活动水平、一般健康和症状性骨关节炎的结果得到验证，以及2)前交叉韧带移植物或对侧前交叉韧带失败。本次修订的目标是在父母资助的最后1.5年(2014年4月至2015年8月)完成对另外1251名重建前交叉韧带患者(已完成86%的2年随访率)的6年无资金支持的月队列随访。这将使我们现有的样本量增加约50%，并将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症状的详细影响。此外，我们将是第一个对前交叉韧带移植物和对侧前交叉韧带失效进行复杂的多变量预测模型的人。纳入较长6年时间间隔的附加变量尤其 对于确定骨性关节炎的长期结果和症状以及同侧和对侧前交叉韧带撕裂的发生率很重要。

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.