Prognosis and predictors of ACL reconstructions using the MOON cohort: a model for comparative effectiveness studies

Abstract

Injury to the anterior cruciate ligament (ACL) threatens an active lifestyle and exposes the patient to risk of early osteoarthritis (OA). ACL reconstruction is typically chosen by individuals to allow a return to their previous work and sports activities. Primary ACL reconstruction (ACLR) has in general been effective at restoring functional stability, but patients' modifiable predictors of both short- and long-term validated outcomes and OA are largely unknown. The Multicenter Orthopaedic Outcomes Network (MOON) consortium was established in 2002 to enroll and longitudinally follow a population cohort of ACL reconstructed patients. The objective was to establish patient-specific predictive models of clinically important outcomes. Over the past 10 years, the overarching aims of this NIAMS-funded prospective multicenter cohort of ACL reconstructions has been threefold: (1) to identify both short- and long-term prognosis and predictors of sports function, activity level, and general health through validated patient-reported outcomes, (2) to identify the symptoms and signs of OA, and (3) to quantify the incidence of ACL reconstruction graft and/or contralateral ACL failures and additional surgical procedures. This manuscript summarizes the Kappa Delta Ann Doner Vaughan Award paper and presentation at the 2012 ORS/AAOS Annual Meeting.

Figure 1

Probability of ACLR graft failure by age and choice of autograft vs. allograft. This represents 95% of 2-year follow-up of 2002 and 2003 MOON cohort. ACLR graft failure was defined as revision ACLR (Kaeding et al, 2011).

Figure 2

KOOS Population Results. The five subscales of KOOS are displayed on horizontal axis and preoperative, 2-year, and 6-year follow-up population results are labeled.

Figure 3

KOOS Knee-related Quality of Life Patient-Specific Predictive Nomogram at Six Years. The nomogram is used to predict a patient-specific outcome score at six years based on summing the individual point total for each variable on the left. For each variable the patient’s result is indicated and the points based on the top point scale are recorded. Then the sum of points is placed on the total points line on the bottom. After the total points are marked, you read the outcome score predicted at six years below.