J Knee Surg 2016; 29(07): 539-542
DOI: 10.1055/s-0036-1593341
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hot Topics in the Multicenter Orthopedics Outcomes Network: Anterior Cruciate Ligament

Robert W. Westermann
1   Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa
,
Thomas Sean Lynch
2   Department of Orthopaedic Surgery, Sports Medicine, Columbia University Medical Center, New York, New York
,
Kurt P. Spindler
3   Department of Orthopaedic Surgery, Cleveland Clinic Sports Health Center, Garfield Heights, Ohio
› Author Affiliations
Further Information

Publication History

06 July 2016

02 August 2016

Publication Date:
19 September 2016 (online)

Abstract

Since 2015, the Multicenter Orthopedic Outcomes Network (MOON) has addressed several factors associated with patient outcome after anterior cruciate ligament (ACL) injury. These factors include predictors of high grade knee laxity, the impact of meniscus treatment on joint space narrowing after surgery, graft selection, treating diabetic patients, predictors of clinically significant pain, and outcomes of patients where meniscus tears were left in situ without treatment. The presence of meniscus tears and generalized laxity predict a lax examination under anesthesia prior to surgery. Allograft reconstructions carry a 5.2 times increased risk of re-tear compared to autograft. Patients with diabetes should be counseled they may be at increased risk (odds ratio 18.8) for infection after surgery. Subsequent ipsilateral knee surgery is the strongest predictor of postoperative pain after ACLR. Stable, partial thickness meniscus tears measuring less than 1 cm can be left alone without treatment with low re-operation rates at 6-years.

 
  • References

  • 1 Gottlob CA, Baker Jr CL, Pellissier JM, Colvin L. Cost effectiveness of anterior cruciate ligament reconstruction in young adults. Clin Orthop Relat Res 1999; (367) 272-282
  • 2 Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 2009; 91 (10) 2321-2328
  • 3 Westermann RW, Wolf BR, Elkins J. Optimizing graft placement in anterior cruciate ligament reconstruction: a finite element analysis. J Knee Surg 2016;
  • 4 Fok AW, Yau WP. Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries. Knee Surg Sports Traumatol Arthrosc 2013; 21 (4) 928-933
  • 5 McCullough KA, Phelps KD, Spindler KP , et al; MOON Group. Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med 2012; 40 (11) 2523-2529
  • 6 Lynch TS, Parker RD, Patel RM , et al; MOON Group. The impact of the Multicenter Orthopaedic Outcomes Network (MOON) research on anterior cruciate ligament reconstruction and orthopaedic practice. J Am Acad Orthop Surg 2015; 23 (3) 154-163
  • 7 Magnussen RA, Reinke EK, Huston LJ, Hewett TE, Spindler KP ; MOON Group. Factors associated with high-grade lachman, pivot shift, and anterior drawer at the time of anterior cruciate ligament reconstruction. Arthroscopy 2016; 32 (6) 1080-1085
  • 8 Jones MH, Spindler KP, Fleming BC , et al. Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: data from the MOON onsite cohort. Osteoarthritis Cartilage 2015; 23 (4) 581-588
  • 9 Wasserstein D, Huston LJ, Nwosu S , et al; MOON Group. KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study. Osteoarthritis Cartilage 2015; 23 (10) 1674-1684
  • 10 Englund M, Roos EM, Lohmander LS. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum 2003; 48 (8) 2178-2187
  • 11 Brophy RH, Wright RW, Huston LJ, Nwosu SK, Spindler KP ; MOON Knee Group. Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2015; 97 (6) 450-454
  • 12 Dunn WR, Wolf BR, Harrell Jr FE, Reinke EK, Huston LJ, Spindler KP ; MOON Knee Group. Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years. J Bone Joint Surg Am 2015; 97 (7) 551-557
  • 13 Fordham R, Skinner J, Wang X, Nolan J ; Exeter Primary Outcome Study Group. The economic benefit of hip replacement: a 5-year follow-up of costs and outcomes in the Exeter Primary Outcomes Study. BMJ Open 2012; 2 (3)
  • 14 Räsänen P, Paavolainen P, Sintonen H , et al. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop 2007; 78 (1) 108-115
  • 15 Brophy RH, Huston LJ, Wright RW , et al. Outcomes of ACL reconstruction in patients with diabetes. Med Sci Sports Exerc 2016; 48 (6) 969-973
  • 16 Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Spindler KP ; MOON Consortium. Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 2015; 43 (7) 1583-1590
  • 17 Wasserstein D, Sheth U, Cabrera A, Spindler KP. A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients. Sports Health 2015; 7 (3) 207-216
  • 18 Duchman KR, Westermann RW, Spindler KP , et al; MOON Knee Group. The fate of meniscus tears left in situ at the time of anterior cruciate ligament reconstruction: a 6-year follow-up study from the MOON cohort. Am J Sports Med 2015; 43 (11) 2688-2695
  • 19 Cox CL, Huston LJ, Dunn WR , et al. Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 2014; 42 (5) 1058-1067