Rupture of the anterior cruciate ligament (ACL) often leads to recurrent knee instability. Modern surgical techniques and rehabilitation protocols are frequently successful in restoring knee function;however, not all patients report excellent outcomes following surgery. While patient-reported outcome scores are widely accepted as the most important measures of outcome following ACL surgery, they are somewhat limited in their ability to pinpoint specific opportunities for improvement of outcomes. In contrast, physical examination allows much more focal assessment of knee laxity;however, these findings may not correlate well with patients'perceptions of knee function in all cases. A key gap in our knowledge is a clear understanding the relationships between physical examination findings and patient-reported outcome scores. The candidate's long-term goal is to become an independent clinician-scientist focused on the treatment of ACL injuries through individualized therapy based on each patient's specific symptoms and injury pattern. Key to accomplishment of this goal is the development of specific surgical and clinical research skills. The candidate and his mentors have developed a training plan consisting of a research project addressing the key knowledge gaps identified above as well as specific training designed to provide the candidate with the requisite skills to independently advance research in this area following completion of the training period.
The first aim of this project will be to definitively quantify relationships betwen postoperative knee laxity and patient-reported outcome scores. Identification of the postoperative physical examination findings that most significantly correlate with patient-reported outcome measures will allow refinement of surgical techniques to more effectively address these physical examination findings. The second and third aims of the study will be to evaluate the influence of pre-operative physical examination findings on post-operative patient- reported outcome scores. These data will facilitate identification of patients at risk for poor outcomes following reconstruction and allow targeting of new interventions to these patients. Completion of this core research project will require the candidate to develop and hone skills in the areas of biostatistics, epidemiology, project and personnel management, scientific writing and communication, teaching, and leadership. This training will be accomplished through the direct mentorship of his advisors as well as through a deliberate, organized curriculum utilizing the opportunities available at Ohio State. Central to the candidate's education will be completion of a Master's Degree in Public Health in the Clinical and Translational Sciences track at the OSU College of Public Health. This training will be supplemented with additional training in biostatistics and epidemiology, formal training in responsible performance of human subjects research, and clinical mentorship. Completion of this project will both answer critical clinical questions and provide the candidate with requisite skills to pursue a career as an independent clinician-scientist.
The use of patient-reported outcome data has demonstrated that not all patients are satisfied with their results after ACL surgery. The goal of this project s to determine which physical examination findings are associated with poorer patient-reported outcomes. This information will help identify patients at risk of poor outcome after ACL surgery and help improve treatment options for these patients.
|Magnussen, Robert A; Trojani, Christophe; Granan, Lars-Petter et al. (2015) Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 23:2339-48|
|Mariscalco, Michael W; Flanigan, David C; Mitchell, Joshua et al. (2013) The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy 29:1948-53|