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 sports function, activity and general health through validated patient-reported outcomes, symptoms and signs of osteoarthritis (OA), and incidence of ACL reconstruction graft and/or contralateral ACL failures. During the past funding cycle we have enrolled over 2,000 patients and have completed two year follow-up on 85% (1989/2340) of our cohort using validated patient-reported outcome questionnaires and 93% (2176/2340) via phone follow-up. In addition, a nested cohort of 125 ACL reconstructed patients returned onsite after 2 years for a comprehensive clinical assessment, radiologic measurements, along with completing their patient-reported assessment. The objective of this competitive renewal is to longitudinally follow this captured cohort at six years utilizing the same validated outcome measurements as well as following incidence of clinical graft and/or contralateral ACL failure. Further, we plan to expand enrollment in the onsite nested cohort to determine the predictors of and the correlates from clinical assessment with both the symptoms and signs of OA and validated outcomes (in terms of sports function, activity, and general health). This grant focuses on the predictors for ACL reconstruction outcome at six-year follow-up. This will be accomplished by three Specific Aims.
Aim 1 will identify the independent predictors of return to sports function, physical activity level, and patient-reported quality of life.
Aim 2 will identify those independent modifiable predictors measured at the time of the ACL reconstruction associated with symptoms of early osteoarthritis at 6 years post-surgery.
Aim 3 will identify incidence of additional surgery performed on patients following ACL reconstruction. Once the predictors for good or bad outcomes are identified, surgeons can be educated in potential modifiable variables to improve the outcome.

Public Health Relevance

This multicenter, multi-surgeon prospective study will allow determination of the clinical predictors of inferior outcomes following ACL reconstruction. Once the predictors for good and poor outcomes are identified, surgeons and patients can be educated to the potential modifiable variables that improve patient's outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR053684-07
Application #
8323986
Study Section
Special Emphasis Panel (ZRG1-MOSS-C (03))
Program Officer
Panagis, James S
Project Start
2006-04-01
Project End
2015-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
7
Fiscal Year
2012
Total Cost
$647,960
Indirect Cost
$156,157
Name
Vanderbilt University Medical Center
Department
Surgery
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Brophy, Robert H; Huston, Laura J; Wright, Rick W et al. (2016) Outcomes of ACL Reconstruction in Patients with Diabetes. Med Sci Sports Exerc 48:969-73
Darnley, James E; Léger-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
Magnussen, Robert A; Reinke, Emily K; Huston, Laura J et al. (2016) Factors Associated With High-Grade Lachman, Pivot Shift, and Anterior Drawer at the Time of Anterior Cruciate Ligament Reconstruction. Arthroscopy 32:1080-5
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
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
Wright, Rick W; Haas, Amanda K; Anderson, Joy et al. (2015) Anterior Cruciate Ligament Reconstruction Rehabilitation: MOON Guidelines. Sports Health 7:239-43
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
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
Mariscalco, Michael W; Magnussen, Robert A; Mitchell, Joshua et al. (2015) How much hamstring graft needs to be in the femoral tunnel? A MOON cohort study. Eur Orthop Traumatol 6:9-13
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

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