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 symptoms of osteoarthritis (OA), sports function, activity and general health through validated patient- reported outcomes, and incidence of ACL reconstruction graft and/or contralateral ACL failures. Our initial grant (R01 AR053684) allowed us to enroll over 2,300 patients and obtain both 2 and 6 year follow-up on this cohort. At both time points, we have been able to obtain a minimum of 85% follow-up using validated patient-reported outcome questionnaires and 93% via phone follow-up. Two of the original three Aims from the parent grant will be advanced in this competitive revision, 1) validated patient-reported outcomes of sports function, activity level, general health, and symptomatic OA, and 2) ACL graft or contralateral ACL failures. The objective of this revision is to complete 6 year follow-up on an additional unfunded MOON cohort of 1251 ACL reconstructed patients (with an already completed 86% 2 year follow-up rate) in the last 1.5 years of the parent grant (4/2014 - 8/2015). This would increase our existing sample size by ~ 50%, and would enable us to build the most comprehensive "personalized" models to address detailed contributions of meniscus and articular cartilage injury and treatment (and their interactions) to several patient reported outcomes and OA symptoms. Furthermore, we would be the first to perform complex multivariable predictive modeling of ACL graft and contralateral ACL failure. The additional variables incorporated into longer 6 year time interval is particularly important for establishing the longer-term outcomes and symptoms of OA and incidence of both ipsilateral and contralateral ACL tears.

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 #
3R01AR053684-09S1
Application #
8679064
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Panagis, James S
Project Start
2006-04-01
Project End
2015-08-31
Budget Start
2014-09-12
Budget End
2015-08-31
Support Year
9
Fiscal Year
2014
Total Cost
$193,995
Indirect Cost
$70,431
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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