The Impact of the Multicenter Orthopaedic Outcomes Network (MOON) Research on Anterior Cruciate Ligament Reconstruction and Orthopaedic Practice

Abstract

With an estimated 200,000 anterior cruciate ligament reconstructions performed annually in the United States, there is an emphasis on determining patient-specific information to help educate patients on expected clinically relevant outcomes. The Multicenter Orthopaedic Outcomes Network consortium was created in 2002 to enroll and longitudinally follow a large population cohort of anterior cruciate ligament reconstructions. The study group has enrolled >4,400 anterior cruciate ligament reconstructions from seven institutions to establish the large level I prospective anterior cruciate ligament reconstruction outcomes cohort. The group has become more than a database with information regarding anterior cruciate ligament injuries; it has helped to establish a new benchmark for conducting multicenter, multisurgeon orthopaedic research. The changes in anterior cruciate ligament reconstruction practice resulting from the group include the use of autograft for high school, college, and competitive athletes in their primary anterior cruciate ligament reconstructions. Other modifications include treatment options for meniscus and cartilage injuries, as well as lifestyle choices made after anterior cruciate ligament reconstruction.

Figure 1

Probability of re-tear (in percentage on vertical axis) for autograft versus allograft by age for the combined consortium cohort.

Figure 2

Illustrations describing each radiographic measurement. A, Harner et al (%). B, Aglietti et al/Jonsson et al (%). C, Notch height (%). D, Clock face on Rosenberg view (degrees). E, Tibial medial-lateral position (%). F, Tibial anterior-posterior position (%). G, Tibial sagittal tunnel angle (degrees). H, Tibial coronal tunnel angle (degrees).

Figure 3

Sagittal three-dimensional CT demonstrating acceptable femoral tunnel placement ranges for depth (c/C) of 0 to 0.55 and height (n/N) of 0.2 to 0.65. The depth was calculated as a percentage of the anterior-to-posterior dimension of the lateral femoral condyle (c/C) with the posterior edge of the condyle as 0%. Tunnel height is the maximal height of the intracondylar notch with the notch apex designated as 0% (n/N).

Figure 4

Axial three-dimensional CT demonstrating acceptable tibial tunnel placement ranges for anterior to posterior (a/A) of 0.3 to 0.55 and medial to lateral (m/M) of 0.4 to 0.51. Tibial tunnel aperature location is calculated as a percentage of plateau width from the medial edge of the tibia (m/M). The depth of the tibia plateau is measured from the anterior edge (a/A).

Figure 5

Health state diagram. The diagram demonstrates the clinical pathway of patients within the decision model. Patient health states include either a stable or an unstable knee, and patients can undergo reoperation consisting of meniscal repair, meniscectomy, manipulation under anesthesia, or hardware removal. ACL = anterior cruciate ligament, OA = osteoarthritis.