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

/ 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.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Special Emphasis Panel (ZRG1-MOSS-C (03))
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Panagis, James S
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Vanderbilt University Medical Center
Schools of Medicine
United States
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MOON Knee Group; Spindler, Kurt P; Huston, Laura J et al. (2018) Ten-Year Outcomes and Risk Factors After Anterior Cruciate Ligament Reconstruction: A MOON Longitudinal Prospective Cohort Study. Am J Sports Med 46:815-825
Houck, Darby A; Kraeutler, Matthew J; Vidal, Armando F et al. (2018) Variance in Anterior Cruciate Ligament Reconstruction Graft Selection based on Patient Demographics and Location within the Multicenter Orthopaedic Outcomes Network Cohort. J Knee Surg 31:472-478
Jones, Morgan H; MOON Knee Group; Spindler, Kurt P et al. (2018) Differences in the Lateral Compartment Joint Space Width After Anterior Cruciate Ligament Reconstruction: Data From the MOON Onsite Cohort. Am J Sports Med 46:876-882
Vega, José F; Spindler, Kurt P (2018) To MOON and Back: Lessons Learned and Experience Gained Along the Way. Clin Sports Med 37:495-503
Nguyen, Joseph T; Wasserstein, David; Reinke, Emily K et al. (2017) Does the Chronicity of Anterior Cruciate Ligament Ruptures Influence Patient-Reported Outcomes Before Surgery? Am J Sports Med 45:541-549
Westermann, Robert W; Jones, Morgan; Wasserstein, David et al. (2017) Clinical and radiographic outcomes of meniscus surgery and future targets for biologic intervention: A review of data from the MOON Group. Connect Tissue Res 58:366-372
Lattermann, Christian; Jacobs, Cale A; Reinke, Emily K et al. (2017) Are Bone Bruise Characteristics and Articular Cartilage Pathology Associated with Inferior Outcomes 2 and 6 Years After Anterior Cruciate Ligament Reconstruction? Cartilage 8:139-145
Jones, Morgan H; Spindler, Kurt P (2017) Risk factors for radiographic joint space narrowing and patient reported outcomes of post-traumatic osteoarthritis after ACL reconstruction: Data from the MOON cohort. J Orthop Res 35:1366-1374
Kaeding, Christopher C; Pedroza, Angela D; Reinke, Emily K et al. (2017) Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time. Arthroscopy 33:2007-2014
Stegmeier, Nicole; Oak, Sameer R; O'Rourke, Colin et al. (2017) No Clinically Significant Difference Between Adult and Pediatric IKDC Subjective Knee Evaluation Scores in Adults. Sports Health 9:450-455

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