Revision anterior cruciate ligament (ACL) reconstruction represents an infrequent but clinically important challenge in orthopaedic practice. It is commonly reported that the results of revision surgery remain inferior to primary ACL 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 multicenter study is necessary to accumulate enough subjects over a reasonable time frame to allow for multivariable analyses. With this in mind, the Multicenter ACL Revision Study (MARS) group was established as an 83 surgeon multicenter consortium 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). Our previous grant (5R01 AR060846) has allowed us to enroll over 1,200 patients and obtain both short (2- year) and mid-term (6-year) follow-up. This study design involves a longitudinal prospective cohort for whom we have baseline, 2-year and 6-year follow-up on. At both follow-up time points, we have been able to obtain a minimum of 80% follow-up using validated patient-reported outcome questionnaires and 92% via phone follow-up. The objective of this grant renewal is to assess the 10-year progression of outcomes following revision ACL reconstruction, and to determine how the initial factors at the time of revision surgery may influence and predict disease progression. New to this proposal is the addition of PROMIS patient reported outcomes to the entire cohort, as well as the addition of a nested cohort, for which we aim to bring back 400 of these enrolled patients for onsite standardized radiographs and physical exam measures. The focus of this renewal application is to characterize the 10-year natural history of this unique dataset, quantified by 3 complementary methodologies: patient-reported outcomes, radiologic and physical exam measures. This renewal will build upon the findings demonstrated at 2 and 6 years and determine if these continue to hold true at long-term follow-up.

Public Health Relevance

/ RELEVANCE Revision ACL reconstruction results in inferior outcome compared with primary reconstructions, thus limiting individuals from returning to their previous activities. This multicenter, multi-surgeon prospective study will allow determination of the long-term 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 which can 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 #
5R01AR060846-08
Application #
10019326
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Washabaugh, Charles H
Project Start
2019-09-02
Project End
2022-08-31
Budget Start
2020-09-01
Budget End
2021-08-31
Support Year
8
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Type
DUNS #
079917897
City
Nashville
State
TN
Country
United States
Zip Code
37232
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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