Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort.

Rick W. Wright, Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavillion, St Louis, MO 63110. .
The American Journal of Sports Medicine (Impact Factor: 4.36). 10/2010; 38(10):1979-86. DOI: 10.1177/0363546510378645
Source: PubMed


Revision anterior cruciate ligament (ACL) reconstruction has worse outcomes than primary reconstructions. Predictors for these worse outcomes are not known. The Multicenter ACL Revision Study (MARS) Group was developed to perform a multisurgeon, multicenter prospective longitudinal study to obtain sufficient subjects to allow multivariable analysis to determine predictors of clinical outcome.
To describe the formation of MARS and provide descriptive analysis of patient demographics and clinical features for the initial 460 enrolled patients to date in this prospective cohort.
Cross-sectional study; Level of evidence, 2.
After training and institutional review board approval, surgeons began enrolling patients undergoing revision ACL reconstruction, recording patient demographics, previous ACL reconstruction methods, intra-articular injuries, and current revision techniques. Enrolled subjects completed a questionnaire consisting of validated patient-based outcome measures.
As of April 1, 2009, 87 surgeons have enrolled a total of 460 patients (57% men; median age, 26 years). For 89%, the reconstruction was the first revision. Mode of failure as deemed by the revising surgeon was traumatic (32%), technical (24%), biologic (7%), combination (37%), infection (<1%), and no response (<1%). Previous graft present at the time of injury was 70% autograft, 27% allograft, 2% combination, and 1% unknown. Sixty-two percent were more than 2 years removed from their last reconstruction. Graft choice for revision ACL reconstruction was 45% autograft, 54% allograft, and more than 1% both allograft and autograft. Meniscus and/or chondral damage was found in 90% of patients.
The MARS Group has been able to quickly accumulate the largest revision ACL reconstruction cohort reported to date. Traumatic reinjury is deemed by surgeons to be the most common single mode of failure, but a combination of factors represents the most common mode of failure. Allograft graft choice is more common in the revision setting than autograft. Concomitant knee injury is extremely common in this population.

Download full-text


Available from: Barton J Mann, Aug 27, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction The sports medicine community has only recently begun to develop and use registries and other large prospective cohorts to evaluate outcomes following anterior cruciate ligament (ACL) reconstruction. There is no study describing the epidemiology of ACL reconstructions in a non-Western society. It is hypothesized that significant differences will be noted between the Brunei patient population and those reported in large Western registries. Materials and methods Demographic data and surgical findings for all patients undergoing ACL reconstruction between January 1, 2008 and December 31, 2010 were collected retrospectively. The resulting data were compared with baseline data from the Scandinavian registries and the Multicenter Orthopaedic Outcome Network (MOON) cohort in the USA. Results A total of 214 ACL reconstructions were performed during the study period. The age of patients undergoing surgery as well as the delay from injury to surgery was relatively similar in Brunei and Scandinavia. The patients in the MOON cohort were generally younger and underwent surgery sooner. The most common activity causing injury was football. All patients in Brunei underwent ACL reconstruction with hamstring autografts. Conclusions Registries provide detailed epidemiological data that can be used to calculate revision rates, assess patient-reported outcome scores, and compare various techniques and implants. Inclusion of cases from an entire country minimizes selection bias and maximizes data volume. This registry will, in the future, be improved by initiating the collection of pre- and post-operative patient-reported outcome scores and improving documentation strategies for cartilage defects. The national registry will generate new data about ACL reconstructions and contribute to better understanding of ACL epidemiology.
    No preview · Article · Sep 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since its establishment in 1982, the Bunnell Traveling Fellowship has sponsored an annually selected member of the American Society for Surgery of the Hand to pursue an in-depth study of a topic germane to the interests of each honoree. My goal, as the 29th Traveling Fellow, was to visit selected sites around the world that have successfully integrated congenital hand research and education with outstanding care of affected children. The purpose of this report was to provide a brief description of my travels and the lessons I have learned regarding the research and teaching of congenital hand surgery.
    No preview · Article · Mar 2011 · The Journal of hand surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This report summarizes the 2010 AOSSM/NIH (American Orthopaedic Society for Sports Medicine/National Institutes of Health) U13 Post-Joint Injury Osteoarthritis II Conference to include the discussion concerning potential study cohorts, assessment considerations, and research priorities. There was strong consensus and enthusiasm for approaching the development of disease-modifying treatments for osteoarthritis through study of "pre-osteoarthritic" cohorts, particularly human subjects under 30 years of age following acute anterior cruciate ligament injuries. Clinical study of acute treatment strategies initiated within a few days after injury will need development of recruitment pathways and short-term proof-of-concept outcome measures that are specific to the intervention being studied. For example, measures of joint inflammation can be used in short-term prospective randomized controlled trials to determine whether an anti-inflammatory intervention was effective in decreasing early inflammation. These short-term clinical trials will need to be followed by longer-term evaluation of the clinical cohorts for joint and cartilage degeneration to determine if the acute intervention affected later development of osteoarthritis. Research priorities were identified in several disciplines, particularly regarding development and validation of quantitative imaging, biomechanics, and biomarker measures of joint structure, composition, and function that predict the accelerated development of osteoarthritis. Systematic study of posttraumatic osteoarthritis is anticipated to advance understanding and treatment of all forms of osteoarthritis.
    Full-text · Article · Jul 2011 · The American Journal of Sports Medicine
Show more