Revision ACL Reconstructions: A Comparative Effectiveness Treatment Study

修正 ACL 重建：比较疗效治疗研究

• 批准号: 8325637
• 负责人: Rick W Wright
• 金额: $ 66.05万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8325637
• 关键词: Address; Adopted; Affect; Allografting; American; Anterior Cruciate Ligament; Articular Range of Motion; Autologous Transplantation; Braces-Orthopedic appliances; Clinical; Clinical Trials; Cohort Analysis; Cohort Studies; Defect; Degenerative polyarthritis; Development; Enrollment; Evidence based practice; Failure; Future; Goals; Grant; Incidence; Individual; Inferior; Injury; Institution; Knee; Knee Osteoarthritis; Lead; Lesion; Location; Measures; Mind; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Pain; Pathology; Patients; Physical activity; Physicians; Postoperative Period; Prevalence; Private Practice; Prospective Studies; Quality of life; Recreation; Rehabilitation therapy; Relative (related person); Reliance; Repeat Surgery; Reporting; Research Design; Risk; Risk Factors; Rupture; Sample Size; Societies; Sports; Sports Medicine; Surgeon; Surgical incisions; Swelling; Symptoms; Techniques; Time; Weight-Bearing state; anterior cruciate ligament reconstruction; base; bone; comparative effectiveness; follow-up; graft failure; improved; prospective; reconstruction; success

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：修订前交叉韧带（ACL）重建代表骨科实践中的临时挑战但在临床上至关重要。技术问题需要特定的修订技术来解决保留的硬件，骨隧道缺陷和隧道放置不正确的并发症。此外，通常报道说，修订手术的结果仍然不如原发性重建。这些较差的结果包括基于患者的结果，膝盖松弛增加，移植率较高，半月板变性和软骨病变。已经提出了较差的结果率的许多原因，包括受损的隧道位置，初级重建过程中未经治疗的病理学以及对同种异体移植的修订更加依赖。为了评估这些和其他因素对结果的贡献，必须确定并前瞻性地识别正在进行修订的大量患者。但是，由于任何一个中心的修订ACL重建相对不频率，需要进行大型的多中心研究才能在合理的时间范围内积累足够的受试者以允许进行多变量分析。考虑到这一点，将多中心ACL修订研究（MARS）组成立为87个外科医生多中心组，以对ACL重建进行前瞻性纵向同伴分析。这是一组学术和私人执业医师，并得到了美国骨科运动学会（AOSSM）的支持和认可。该小组已经将ACL重建患者纳入了三年以上，并积累了800多名患者。该赠款使用了前瞻性队列研究设计，并专注于两年随访的ACL修订结果的可修改预测指标。总体目标是阐明负责ACL修订成功或失败的因素。我们假设在修订ACL重建时存在可修改的自变量，该变量将预测ACL重建结果。这将通过关注四个特定目标来实现。特定的目标1将确定移植物选择是否预测了移植，重新手术，恢复运动功能和活动后2年的活动的发生率。具体的目标2将确定可修改的手术因素是否影响移植率并恢复运动功能。特定的目标3将确定在修订后的ACL重建时测量的半月板和软骨损伤的患病率和/或程度是否可以预测活动后2年的活动水平，恢复运动功能以及疼痛和肿胀症状。特定目标4是探索性目的，它决定了修订ACL手术后2年的各种康复因素是否影响移植物的发生率或重返运动活动。这项研究的结果将推动骨科运动医学领域，因为它将指导从业者最适当地选择用于重建，修改外科手术方法和技术的移植物，并以一种提供最佳结果的方式管理半月板和软骨伤害。