Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

描述（由申请人提供）：Tofler估计，每年有2000万儿童和青少年参加有组织的体育运动，前十字韧带（ACL）断裂是影响体力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20万例ACL重建（ACLR）作为标准护理，其依据是改善了器械松弛性，恢复运动的愿望，以及减少了未来膝关节损伤的证据这些前交叉韧带损伤对受伤者的生活质量、患骨关节炎的风险和长期残疾都有直接和长期的影响。虽然有几项研究指出，50%的前交叉韧带损伤和ACLR后膝关节损伤后关节炎导致严重的长期残疾，但没有研究确定预测关节炎症状和体征的发生率和时间的因素，也没有研究确定这些因素对患者相关生活质量的影响。此外，没有研究调查各种因素，包括术后活动和其他术后干预可能对ACLR术后患者相关的生活质量、骨关节炎和复发性损伤或手术的作用。我们建立了多中心骨科结果网络（MOON），这是一项对2362例ACLR患者（并持续入组）的前瞻性队列研究，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定。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，包括生活质量（AIM 1）、OA的症状和体征（AIM 2）以及复发性韧带损伤和手术（AIM 3）。建议的独立危险因素包括患者的特征（年龄、性别、BMI、活动水平、临床膝关节排列）及其损伤（损伤时听到的“砰”声、并发半月板、关节软骨和副韧带损伤），以及对并发半月板和关节软骨损伤的治疗决策。这些面向患者的工具包括：1)膝关节损伤和骨关节炎结局评分（oos）， 2)西安大略省和麦克马斯特大学关节炎指数（WOMAC）， 3)短表36 (SF-36)，以及4)国际和膝关节文献委员会（IKDC）问卷调查。对于骨性关节炎的征象，需要专门的站立x光片。这项研究将是对接受ACLR的男性和女性进行的最大的前瞻性队列研究，旨在确定三种临床相关不良结果的危险因素。这项研究的结果将通过提高我们管理和咨询患者预后的能力，指导关节内损伤和未来患者活动的决策，以及确定未来实验试验中可改变的独立危险因素的潜力来推进科学知识。

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.