Candidate: Warren R. Dunn, MD, MPH, Assistant Professor of Orthopaedics at Vanderbilt University with a secondary appointment as Assistant Professor in the Department of Medicine &Public Health at the Center for Health Services Research. He completed the American Academy of Orthopaedic Surgeons / Orthopaedic Research and Education Foundation Health Services Research Fellowship at the Hospital for Special Surgery on the Sports Medicine and Shoulder Service. In this K23 application he proposes a comprehensive five-year career development plan that includes advanced coursework and training in clinical epidemiology, biostatistics, clincal trial design, and to conduct a mentored research project investigating outcomes after anterior cruciate ligament (ACL) reconstruction in order to achieve the goal of becoming an independent surgeon scientist. Project Rationale: Physical activity and fitness is one of the focus areas of Healthy People 2010, and sports participation is increasing. In accord, the number of ACL injuries and subsequent ACL reconstructions is increasing at an estimated annual cost of 2 billion dollars. Available evidence shows that ACL reconstructions have been successful in restoring preoperative function at two years, but these studies have utilized non-validated outcome measures, often lack long-term follow-up, and have left risk factors for poor outcome, graft failure, and additional surgical procedures ill defined. Design: A multi-center observational cohort study involving an established Multi-center Orthopaedic Outcomes Network (MOON) will be utilized. The purpose of the proposed mentored research is to test the hypothesis that objective predictors recorded at the time of ACL reconstruction are associatedwith validated outcome instruments and arthritis (Aim 1), and additional surgical procedures and graft failure (Aim 2). Vanderbilt is a robust academic environment capable of providing the education, training, and mentorship necessary to enable Dr. Dunn to become an independent patient-oriented clinician scientist. The ACL is the most frequently injured ligament in the body, and disruption of this important stablizer leads to giving way episodes that cause further injury to the knee. ACL reconstruction restores stability to the knee, however, it is unclear if surgery prevents later arthritis of the knee. Identifying factors associated with quality of life and arthritis is critical because arthritis, particularly in young adults, is a major public health concern.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Panagis, James S
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Vanderbilt University Medical Center
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Darnley, James E; L├ęger-St-Jean, Benjamin; Pedroza, Angela D et al. (2016) Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon: A MOON Cohort Study. Orthop J Sports Med 4:2325967116662249
Dunn, Warren R; Wolf, Brian R; Harrell Jr, Frank E et al. (2015) Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years. J Bone Joint Surg Am 97:551-7
Wasserstein, D; Huston, L J; Nwosu, S et al. (2015) KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study. Osteoarthritis Cartilage 23:1674-84
Duchman, Kyle R; Westermann, Robert W; Spindler, Kurt P et al. (2015) The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study From the MOON Cohort. Am J Sports Med 43:2688-95
Kaeding, Christopher C; Pedroza, Angela D; Reinke, Emily K et al. (2015) Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort. Am J Sports Med 43:1583-90
Jones, M H; Spindler, K P; Fleming, B C et al. (2015) Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: data from the MOON onsite cohort. Osteoarthritis Cartilage 23:581-8
Lynch, T Sean; Parker, Richard D; Patel, Ronak M et al. (2015) The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice. J Am Acad Orthop Surg 23:154-63
MOON Shoulder Group:; Unruh, Kenneth P; Kuhn, John E et al. (2014) The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg 23:1052-8
Cox, Charles L; Huston, Laura J; Dunn, Warren R et al. (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42:1058-67
Spindler, Kurt P; Parker, Richard D; Andrish, Jack T et al. (2013) Prognosis and predictors of ACL reconstructions using the MOON cohort: a model for comparative effectiveness studies. J Orthop Res 31:2-9

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