Prognosis and Predictors of ACL Reconstruction: A Multicenter Cohort Study

ACL 重建的预后和预测因素：多中心队列研究

• 批准号: 8734207
• 负责人: Kurt Paul Spindler
• 金额: $ 57.37万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-25 至 2015-09-17
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8734207
• 关键词: Age; Allografting; Anterior Cruciate Ligament; Basic Science; Cartilage injury; Characteristics; Clinical; Clinical Research; Clinical assessments; Cohort Studies; Contralateral; Data; Decision Making; Degenerative polyarthritis; Enrollment; Evaluation; Excision; Failure; Funding; Future; Gender; Grant; Health; Hearing; Incidence; Individual; Inferior; Injury; Ipsilateral; Joints; Knee; Knowledge; Lead; Life Style; Measurement; Measures; Meniscus structure of joint; Modeling; Operative Surgical Procedures; Orthopedics; Outcome; Pain; Patient Outcomes Assessments; Patients; Physical activity; Physicians; Population; Prevention; Prospective Studies; Quality of life; Questionnaires; Reporting; Research; Risk; Risk Factors; SF-36; Severities; Signs and Symptoms; Site; Smoking; Smoking Status; Source; Sports; Surgeon; Symptoms; Techniques; Telephone; Testing; Time; Work; anterior cruciate ligament reconstruction; anterior cruciate ligament rupture; articular cartilage; cohort; design; disability; follow-up; graft failure; improved; instrument; modifiable risk; outcome forecast; predictive modeling; prospective; standard of care; time interval

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：前十字韧带 (ACL) 损伤会对积极的生活方式造成威胁，并使患者面临早期骨关节炎的风险。 ACL 重建通常由个人选择，以允许他们恢复以前的工作和体育活动。一般而言，初次 ACL 重建的结果有助于恢复功能稳定性，但患者的长期结果仍不清楚。多中心骨科结果网络 (MOON) 是一个已建立的联盟，旨在招募并纵向跟踪 ACL 重建患者群体，以确定 ACL 重建长期结果的可修改预测因子（或风险因素），从而建立患者特异性临床重要结果的预测模型。这个前瞻性多中心 ACL 重建队列的目的是通过经过验证的患者报告的结果、骨关节炎 (OA) 的症状和体征以及发病率来确定长期预后以及运动功能、活动和总体健康的潜在可修改预测因素ACL 重建移植物和/或对侧 ACL 失败。在过去的资助周期中，我们已经招募了 2,000 多名患者，并使用经过验证的患者报告结果调查问卷对我们队列中的 85% (1989/2340) 完成了两年的随访，并通过电话随访完成了 93% (2176/2340) 的随访。此外，由 125 名 ACL 重建患者组成的嵌套队列在 2 年后返回现场进行全面的临床评估、放射学测量，并完成患者报告的评估。此次竞争性更新的目的是利用相同的经过验证的结果测量以及临床移植物和/或对侧 ACL 失败的发生率，对捕获的队列进行六年纵向跟踪。此外，我们计划扩大现场嵌套队列的招募范围，以确定 OA 症状和体征的临床评估以及验证结果（在运动功能、活动和一般健康方面）的预测因素和相关性。这笔资助的重点是六年随访时 ACL 重建结果的预测因素。这将通过三个具体目标来实现。目标 1 将确定恢复运动功能、身体活动水平和患者报告的生活质量的独立预测因素。目标 2 将确定在 ACL 重建时测量的那些独立的可修改预测因子，这些预测因子与术后 6 年的早期骨关节炎症状相关。目标 3 将确定 ACL 重建后患者进行额外手术的发生率。一旦确定了好或坏结果的预测因素，外科医生就可以接受潜在的可修改变量的教育，以改善结果。