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 #
5R01AR053684-08
Application #
8515742
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
2013-09-01
Budget End
2014-08-31
Support Year
8
Fiscal Year
2013
Total Cost
$557,571
Indirect Cost
$127,696
Name
Vanderbilt University Medical Center
Department
Surgery
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Mather 3rd, Richard C; Hettrich, Carolyn M; Dunn, Warren R et al. (2014) Cost-Effectiveness Analysis of Early Reconstruction Versus Rehabilitation and Delayed Reconstruction for Anterior Cruciate Ligament Tears. Am J Sports Med 42:1583-91
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
Cox, Charles L; Spindler, Kurt P; Leonard, James P et al. (2014) Do newer-generation bioabsorbable screws become incorporated into bone at two years after ACL reconstruction with patellar tendon graft?: A cohort study. J Bone Joint Surg Am 96:244-50
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
Magnussen, Robert A; Pedroza, Angela D; Donaldson, Christopher T et al. (2013) Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor? Knee Surg Sports Traumatol Arthrosc 21:2029-34
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
Magnussen, Robert A; Flanigan, David C; Pedroza, Angela D et al. (2013) Platelet rich plasma use in allograft ACL reconstructions: two-year clinical results of a MOON cohort study. Knee 20:277-80
Hettrich, Carolyn M; Dunn, Warren R; Reinke, Emily K et al. (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41:1534-40
Spindler, Kurt P; Huston, Laura J; Wright, Rick W et al. (2011) The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 39:348-59
Reinke, Emily K; Spindler, Kurt P; Lorring, Dawn et al. (2011) Hop tests correlate with IKDC and KOOS at minimum of 2ýýyears after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1806-16

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