The continuation of this prospective international cohort study of patients after acute unilateral anterior cruciate ligament will help influence the care of the 200,000 or more Americans who rupture their ACL's each year by answering important clinical questions regarding the role and impact of dynamic knee stability on patient outcomes. The inclusion of the international sample is allowing us to test the conventional wisdom that drives surgical decision-making in the treatment of ACL rupture in the United States. In addition, the further elucidation of how those with different early compensation strategies for the injury are affected by neuromuscular training and reconstructive surgery can allow us to derive and test meaningful prediction rules for the management of these individuals. Our nearly ten year collaboration with Oslo University Hospital in Norway, where the practice pattern requires a substantial period of rehabilitation before they undergo reconstructive surgery, provided the platform for this unique cohort. To answer these questions, our international, multidisciplinary team has performed clinical and functional evaluation in persons classified by our screening examination before and after unilateral ACLR. The important results we obtained from the past five years demonstrate that there is a differential response to ACL injury that can be affected by rehabilitation, but also demonstrated that as rehabilitation continues before surgery, stability strategies change. Categories are fluid, non-copers can become more stable, potential copers can become unstable and while surgery introduces passive stability, successful outcome is not inevitable. Intent to return to previous level of actiity is not a predictor of actual return. Prediction of medium term (1 year) success from modifiable impairments and physical performance measures is robust and prediction is better after a period of rehabilitation than acutely after injury. We have an extremely rich existing base of data (cohorts of 130-150 active individuals at each site were enrolled within 3 months of injury and followed prospectively) with more than a 90% on site follow-up at 1 year and a tremendous opportunity to follow this well-characterized sample. Longitudinal data have been used to assess response to rehabilitation and surgery, return to activity and reinjury in the medium term (up to one year). Continued follow-up of this cohort will allow us to focus on many important questions with a continued goal of examining similarities and differences between the surgically treated and the non- surgically treated group and the US and Norwegian samples 2 and 5 -7 years after injury. The proposed studies will extend our previous findings and will provide important evidence that will inform the treatment of individuals with ACL rupture across the spectrum of compensation strategies and treatment options. .

Public Health Relevance

This international cohort proposed studies will begin to elucidate the particular clinical markers that contribute to the success or failure following ACL rupture and reconstruction and/or return to full activity and provide clinicians with practical, useful and evidence-based treatment options that may improve function after ACL injury or reconstruction.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Method to Extend Research in Time (MERIT) Award (R37)
Project #
3R37HD037985-12S1
Application #
8802908
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Cruz, Theresa
Project Start
2001-02-08
Project End
2017-02-28
Budget Start
2014-08-27
Budget End
2015-02-28
Support Year
12
Fiscal Year
2014
Total Cost
$64,529
Indirect Cost
$22,353
Name
University of Delaware
Department
Other Health Professions
Type
Schools of Allied Health Profes
DUNS #
059007500
City
Newark
State
DE
Country
United States
Zip Code
19716
Wellsandt, Elizabeth; Failla, Mathew J; Snyder-Mackler, Lynn (2017) Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther 47:334-338
Nawasreh, Zakariya; Logerstedt, David; Cummer, Kathleen et al. (2017) Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. Br J Sports Med :
Khandha, Ashutosh; Manal, Kurt; Wellsandt, Elizabeth et al. (2017) Gait mechanics in those with/without medial compartment knee osteoarthritis 5 years after anterior cruciate ligament reconstruction. J Orthop Res 35:625-633
Nawasreh, Zakariya; Logerstedt, David; Cummer, Kathleen et al. (2017) Do Patients Failing Return-to-Activity Criteria at 6 Months After Anterior Cruciate Ligament Reconstruction Continue Demonstrating Deficits at 2 Years? Am J Sports Med 45:1037-1048
Eitzen, Ingrid; Grindem, Hege; Nilstad, Agnethe et al. (2016) Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears: Differences and Clinical Implications. Orthop J Sports Med 4:2325967116667717
Failla, Mathew J; Logerstedt, David S; Grindem, Hege et al. (2016) Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts. Am J Sports Med 44:2608-2614
Grindem, Hege; Snyder-Mackler, Lynn; Moksnes, HÃ¥vard et al. (2016) Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 50:804-8
Grindem, H; Granan, L P; Risberg, M A et al. (2015) How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 49:385-9
Logerstedt, David; Arundale, Amelia; Lynch, Andrew et al. (2015) A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC). Braz J Phys Ther :
Lynch, Andrew D; Logerstedt, David S; Grindem, Hege et al. (2015) Consensus criteria for defining 'successful outcome' after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med 49:335-42

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