. 2024 Nov 14;12(11):23259671241291920.

doi: 10.1177/23259671241291920. eCollection 2024 Nov.

A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort

MARS Group; Kinjal Vasavada¹, Vrinda Vasavada², Jay Moran¹, Sai Devana³, Changhee Lee⁴, Sharon L Hame³, Laith M Jazrawi², Orrin H Sherman², Laura J Huston⁵, Amanda K Haas⁶, Christina R Allen¹, Daniel E Cooper⁷, Thomas M DeBerardino⁸, Kurt P Spindler⁹, Michael J Stuart¹⁰, Annunziato Ned Amendola¹¹, Christopher C Annunziata¹², Robert A Arciero¹³, Bernard R Bach Jr¹⁴, Champ L Baker 3rd¹⁵, Arthur R Bartolozzi¹⁶, Keith M Baumgarten¹⁷, Jeffrey H Berg¹⁸, Geoffrey A Bernas¹⁹, Stephen F Brockmeier²⁰, Robert H Brophy⁶, Charles A Bush-Joseph¹⁴, J Brad Butler V²¹, James L Carey²², James E Carpenter²³, Brian J Cole¹⁴, Jonathan M Cooper²⁴, Charles L Cox⁵, R Alexander Creighton²⁵, Tal S David²⁶, Warren R Dunn²⁷, David C Flanigan²⁸, Robert W Frederick²⁹, Theodore J Ganley³⁰, Charles J Gatt Jr³¹, Steven R Gecha³², James Robert Giffin³³, Jo A Hannafin³⁴, Norman Lindsay Harris Jr³⁵, Keith S Hechtman³⁶, Elliott B Hershman³⁷, Rudolf G Hoellrich³⁸, David C Johnson³⁹, Timothy S Johnson³⁹, Morgan H Jones⁴⁰, Christopher C Kaeding²⁸, Ganesh V Kamath²⁵, Thomas E Klootwyk⁴¹, Bruce A Levy⁴², C Benjamin Ma⁴³, G Peter Maiers 2nd⁴¹, Robert G Marx³⁴, Matthew J Matava⁶, Gregory M Mathien⁴⁴, David R McAllister⁴⁵, Eric C McCarty⁴⁶, Robert G McCormack⁴⁷, Bruce S Miller²³, Carl W Nissen⁴⁸, Daniel F O'Neill⁴⁹, Brett D Owens⁵⁰, Richard D Parker⁹, Mark L Purnell⁵¹, Arun J Ramappa⁵², Michael A Rauh¹⁹, Arthur C Rettig⁴¹, Jon K Sekiya²³, Kevin G Shea⁵³, James R Slauterbeck⁵⁴, Matthew V Smith⁶, Jeffrey T Spang²⁵, Steven J Svoboda⁵⁵, Timothy N Taft²⁵, Joachim J Tenuta⁵⁶, Edwin M Tingstad⁵⁷, Armando F Vidal⁵⁸, Darius G Viskontas⁵⁹, Richard A White⁶⁰, James S Williams Jr⁶¹, Michelle L Wolcott⁶², Brian R Wolf⁶³, Rick W Wright⁵, James J York⁶⁴

Affiliations

¹ Yale University, New Haven, Connecticut, USA.
² NYU Hospital for Joint Diseases, New York, New York, USA.
³ David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.
⁴ Korea University, Seoul, Republic of Korea.
⁵ Vanderbilt University, Nashville, Tennessee, USA.
⁶ Washington University in St Louis, St Louis, Missouri, USA.
⁷ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁸ UT Health, San Antonio, Texas, USA.
⁹ Cleveland Clinic, Cleveland, Ohio, USA.
¹⁰ Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Duke University, Durham, North Carolina, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹³ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁴ Rush University Medical Center, Chicago, Illinois, USA.
¹⁵ The Hughston Clinic, Columbus, Georgia, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
¹⁷ Orthopedic Institute, Sioux Falls, South Dakota, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, Virginia, USA.
¹⁹ State University of New York at Buffalo, Buffalo, New York, USA.
²⁰ University of Virginia, Charlottesville, Virginia, USA.
²¹ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²² University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²³ University of Michigan, Ann Arbor, Michigan, USA.
²⁴ HealthPartners Specialty Center, St Paul, Minnesota, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
²⁶ Synergy Specialists Medical Group, San Diego, California, USA.
²⁷ Fondren Orthopedic Group, Houston, Texas, USA.
²⁸ The Ohio State University, Columbus, Ohio, USA.
²⁹ The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³⁰ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³¹ University Orthopaedic Associates LLC, Princeton, New Jersey, USA.
³² Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³³ Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³⁴ Hospital for Special Surgery, New York, New York, USA.
³⁵ Grand River Health, Rifle, Colorado, USA.
³⁶ Miami Orthopedics and Sports Medicine Institute, Coral Gables, Florida, USA.
³⁷ Lenox Hill Hospital, New York, New York, USA.
³⁸ Slocum Research and Education Foundation, Eugene, Oregon, USA.
³⁹ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁰ Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.
⁴² Orlando Health, Orlando, Florida, USA.
⁴³ University of California at San Francisco, San Francisco, California, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, Tennessee, USA.
⁴⁵ University of California at Los Angeles, Los Angeles, California, USA.
⁴⁶ University of Colorado-Denver School of Medicine, Denver, Colorado, USA.
⁴⁷ University of British Columbia/Fraser Health Authority, New Westinster, British Columbia, Canada.
⁴⁸ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁴⁹ The Alpine Clinic, Plymouth, New Hampshire, USA.
⁵⁰ Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
⁵¹ Valley Ortho, Aspen, Colorado, USA.
⁵² Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵³ Stanford University, Palo Alto, California, USA.
⁵⁴ UNC Health Southeastern, Lumberton, North Carolina, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, New York, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁵⁸ The Steadman Clinic, Vail, Colorado, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶¹ Cleveland Clinic, Euclid, Ohio, USA.
⁶² University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, Maryland, USA.

PMID: 39555321
PMCID: PMC11565622
DOI: 10.1177/23259671241291920

A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort

MARS Group et al. Orthop J Sports Med. 2024.

. 2024 Nov 14;12(11):23259671241291920.

doi: 10.1177/23259671241291920. eCollection 2024 Nov.

Authors

Affiliations

¹ Yale University, New Haven, Connecticut, USA.
² NYU Hospital for Joint Diseases, New York, New York, USA.
³ David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.
⁴ Korea University, Seoul, Republic of Korea.
⁵ Vanderbilt University, Nashville, Tennessee, USA.
⁶ Washington University in St Louis, St Louis, Missouri, USA.
⁷ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁸ UT Health, San Antonio, Texas, USA.
⁹ Cleveland Clinic, Cleveland, Ohio, USA.
¹⁰ Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Duke University, Durham, North Carolina, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹³ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁴ Rush University Medical Center, Chicago, Illinois, USA.
¹⁵ The Hughston Clinic, Columbus, Georgia, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
¹⁷ Orthopedic Institute, Sioux Falls, South Dakota, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, Virginia, USA.
¹⁹ State University of New York at Buffalo, Buffalo, New York, USA.
²⁰ University of Virginia, Charlottesville, Virginia, USA.
²¹ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²² University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²³ University of Michigan, Ann Arbor, Michigan, USA.
²⁴ HealthPartners Specialty Center, St Paul, Minnesota, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
²⁶ Synergy Specialists Medical Group, San Diego, California, USA.
²⁷ Fondren Orthopedic Group, Houston, Texas, USA.
²⁸ The Ohio State University, Columbus, Ohio, USA.
²⁹ The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³⁰ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³¹ University Orthopaedic Associates LLC, Princeton, New Jersey, USA.
³² Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³³ Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³⁴ Hospital for Special Surgery, New York, New York, USA.
³⁵ Grand River Health, Rifle, Colorado, USA.
³⁶ Miami Orthopedics and Sports Medicine Institute, Coral Gables, Florida, USA.
³⁷ Lenox Hill Hospital, New York, New York, USA.
³⁸ Slocum Research and Education Foundation, Eugene, Oregon, USA.
³⁹ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁰ Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.
⁴² Orlando Health, Orlando, Florida, USA.
⁴³ University of California at San Francisco, San Francisco, California, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, Tennessee, USA.
⁴⁵ University of California at Los Angeles, Los Angeles, California, USA.
⁴⁶ University of Colorado-Denver School of Medicine, Denver, Colorado, USA.
⁴⁷ University of British Columbia/Fraser Health Authority, New Westinster, British Columbia, Canada.
⁴⁸ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁴⁹ The Alpine Clinic, Plymouth, New Hampshire, USA.
⁵⁰ Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
⁵¹ Valley Ortho, Aspen, Colorado, USA.
⁵² Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵³ Stanford University, Palo Alto, California, USA.
⁵⁴ UNC Health Southeastern, Lumberton, North Carolina, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, New York, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁵⁸ The Steadman Clinic, Vail, Colorado, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶¹ Cleveland Clinic, Euclid, Ohio, USA.
⁶² University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, Maryland, USA.

PMID: 39555321
PMCID: PMC11565622
DOI: 10.1177/23259671241291920

Abstract

Background: As machine learning becomes increasingly utilized in orthopaedic clinical research, the application of machine learning methodology to cohort data from the Multicenter ACL Revision Study (MARS) presents a valuable opportunity to translate data into patient-specific insights.

Purpose: To apply novel machine learning methodology to MARS cohort data to determine a predictive model of revision anterior cruciate ligament reconstruction (rACLR) graft failure and features most predictive of failure.

Study design: Cohort study; Level of evidence, 3.

Methods: The authors prospectively recruited patients undergoing rACLR from the MARS cohort and obtained preoperative radiographs, surgeon-reported intraoperative findings, and 2- and 6-year follow-up data on patient-reported outcomes, additional surgeries, and graft failure. Machine learning models including logistic regression (LR), XGBoost, gradient boosting (GB), random forest (RF), and a validated ensemble algorithm (AutoPrognosis) were built to predict graft failure by 6 years postoperatively. Validated performance metrics and feature importance measures were used to evaluate model performance.

Results: The cohort included 960 patients who completed 6-year follow-up, with 5.7% (n = 55) experiencing graft failure. AutoPrognosis demonstrated the highest discriminative power (model area under the receiver operating characteristic curve: AutoPrognosis, 0.703; RF, 0.618; GB, 0.660; XGBoost, 0.680; LR, 0.592), with well-calibrated scores (model Brier score: AutoPrognosis, 0.053; RF, 0.054; GB, 0.057; XGBoost, 0.058; LR, 0.111). The most important features for AutoPrognosis model performance were prior compromised femoral and tibial tunnels (placement and size) and allograft graft type used in current rACLR.

Conclusion: The present study demonstrated the ability of the novel AutoPrognosis machine learning model to best predict the risk of graft failure in patients undergoing rACLR at 6 years postoperatively with moderate predictive ability. Femoral and tibial tunnel size and position in prior ACLR and allograft use in current rACLR were all risk factors for rACLR failure in the context of the AutoPrognosis model. This study describes a unique model that can be externally validated with larger data sets and contribute toward the creation of a robust rACLR bedside risk calculator in future studies.

Registration: NCT00625885 (ClinicalTrials.gov identifier).

Keywords: ACL revision; femoral tunnel; graft failure; machine learning; tibial tunnel.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant 5R01-AR060846). See Supplemental Material for individual disclosures. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

**Figure 1.**
AutoPrognosis design diagram.

**Figure 2.**
(A) Receiver operating characteristic curves and (B) precision-recall curves for the AutoPrognosis and logistic regression models.

**Figure 3.**
Partial dependence plots of predicted risk of graft failure after revision anterior cruciate ligament reconstruction (ACLR) based on (A) graft type used in current revision ACLR, (B) femoral tunnel placement in prior ACLR, and (C) tibial tunnel placement in prior ACLR.

See this image and copyright information in PMC

References

1. Alaa A, van der Schaar M. AutoPrognosis: automated clinical prognostic modeling via Bayesian optimization with structured kernel learning. Presented at: Proceedings of the 35th International Conference on Machine Learning; July 10-15, 2018; Stockholm, Sweden. Accessed October 13, 2024. https://proceedings.mlr.press/v80/alaa18b.html
1. Anaconda. Anaconda software distribution. Accessed October 13, 2024. https://anaconda.com
1. Beam AL, Kohane IS. Big data and machine learning in health care. JAMA. 2018;319(13):1317-1318. - PubMed
1. Bedi A, Maak T, Musahl V, et al.. Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important? Am J Sports Med. 2011;39(2):366-373. - PubMed
1. Branche K, Bradsell HL, Lencioni A, Frank RM. Sex-Based Differences in Adult ACL Reconstruction Outcomes. Curr Rev Musculoskelet Med. 2022;15(6):645-650 - PMC - PubMed

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A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort

Affiliations

A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous