Revision anterior cruciate ligament (ACL) reconstruction represents an infrequent but clinically important challenge in orthopaedic practice. Technical issues require specific revision techniques to address complications such as retained hardware, bone tunnel defects, and incorrect tunnel placement. Moreover, it is commonly reported that the results of revision surgery remain inferior to primary reconstructions. These poorer outcomes include worse patient based outcomes, increased knee laxity, higher graft failure rate, meniscal degeneration, and chondral lesions. A number of reasons for the poorer outcome rate have been proposed, including compromised tunnel location, pathology untreated during the primary reconstruction, and greater reliance on allografts for revisions. In order to evaluate the contributions of these and other factors to outcome, large numbers of patients who are undergoing revisions must be identified and followed prospectively. However, due to the relative infrequency of revision ACL reconstructions in any one center, a large multi-center study is necessary to accumulate enough subjects over a reasonable time frame to allow for multivariable analyses. With this in mind, the Multi-center ACL Revision Study (MARS) group was established as an 87 surgeon multi-center group to perform a prospective longitudinal cohort analysis of revision ACL reconstruction. This is a mixed group of academic and private practice physicians and has been supported and endorsed by the American Orthopedic Society for Sports Medicine (AOSSM). The group has been enrolling revision ACL reconstruction patients for over three years and has accumulated greater than 800 patients. This grant uses a prospective cohort study design and focuses on the modifiable predictors for ACL revision outcome at two-year follow-up. The overall goal is to elucidate the factors responsible for success or failure of ACL revision. We hypothesize that modifiable independent variables exist at the time of revision ACL reconstruction that will predict revision ACL reconstruction outcomes. This will be accomplished by focusing on four Specific Aims.
Specific Aim 1 will determine if graft choice predicts incidence of graft rerupture, reoperation, return to sports function and activity level 2 years post-surgery.
Specific Aim 2 will determine if modifiable surgical factors influence graft rerupture rates and return to sports function.
Specific Aim 3 will determine if both prevalence and/or degree of meniscal and chondral damage measured at the time of the revision ACL reconstruction predicts activity level, return to sports function, and pain and swelling symptoms 2 years post-surgery.
Specific Aim 4 is an exploratory aim, which determines if various rehabilitation factors influence the incidence of graft rerupture or return to sports activity 2 years following revision ACL surgery. The results of this study will drive the field of Orthopaedics Sports Medicine, in that it will guide practitioners to most appropriately choose the graft for reconstruction, modify surgical approaches and techniques, and manage meniscal and chondral injuries in a way to provide optimal outcome.

Public Health Relevance

Revision ACL reconstruction results in inferior outcome compared with primary reconstructions, thus limiting individuals from returning to their previous activities. This multicenter, prospective study will allow determination of the clinical predictors of success or failure following revision ACL surgery. Once the predictors for outcome are identified, these can be potentially modified to improve patients'results.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Musculoskeletal Rehabilitation Sciences Study Section (MRS)
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Panagis, James S
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Washington University
Schools of Medicine
Saint Louis
United States
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MARS Group; Cooper, Daniel E; Dunn, Warren R et al. (2018) Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group. Am J Sports Med 46:2836-2841
MARS Group; Allen, Christina R; Anderson, Allen F et al. (2017) Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 45:2586-2594
MARS Group; Ding, David Y; Zhang, Alan L et al. (2017) Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort. Am J Sports Med 45:2068-2076
MARS Group (2016) Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 44:1671-9
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
Group, Mars (2016) Factors Influencing Graft Choice in Revision Anterior Cruciate Ligament Reconstruction in the MARS Group. J Knee Surg 29:458-63
Mars Group (2016) The Development and Early to Midterm Findings of the Multicenter Revision Anterior Cruciate Ligament Study. J Knee Surg 29:528-532
Magnussen, Robert A; Trojani, Christophe; Granan, Lars-Petter et al. (2015) Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 23:2339-2348
Brophy, Robert H; Haas, Amanda K; Huston, Laura J et al. (2015) Association of Meniscal Status, Lower Extremity Alignment, and Body Mass Index With Chondrosis at Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 43:1616-22
Matava, Matthew J; Arciero, Robert A; Baumgarten, Keith M et al. (2015) Multirater agreement of the causes of anterior cruciate ligament reconstruction failure: a radiographic and video analysis of the MARS cohort. Am J Sports Med 43:310-9

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