The Multicenter Orthopaedics Outcomes Network Group and the Effects of Obesity and Body Weight on the Results of Anterior Cruciate Ligament Reconstruction

Approximately 175,000–200,000 anterior cruciate ligament (ACL) reconstructions occur each year at a cost to society of 1–2 billion dollars. These injuries generally occur in younger, more active individuals, with the goal of surgical reconstruction to restore knee biomechanics that allow patients to return to cutting and pivoting sports. Additionally, this procedure can help decrease the risk of subsequent menisci and articular cartilage damage, thus potentially slowing the process of posttraumatic knee osteoarthritis. ACL reconstruction is considered the standard of care for patients with knee instability who participate in high-demand activities.

Multicenter Orthopaedics Outcomes Network Group

The Multicenter Orthopaedics Outcomes Network (MOON) has been instrumental in the evaluation and research of these patients for the past 10 years. This group has prospectively evaluated over 3500 ACL reconstruction patients from seven institutions to determine the prognosis and predictors of ACL reconstruction outcomes. Early work helped establish patient-reported outcomes as an appropriate method for assessing patient outcome as opposed to functional testing. The data collected have helped establish patient-specific statistical models to help clarify modifiable and nonmodifiable predictors related to injury, intraoperative decision making and treatment, postoperative rehabilitation protocols, and behavioral characteristics that contribute to a spectrum of clinically relevant outcomes. Additionally, when compared with rehabilitation, ACL reconstruction has been found to be cost-effective in both the short and long term. The group has concluded that limiting ACL reconstruction could potentially be harmful to not only the patient, due to the risk of the development of osteoarthritis, but also society, as ACL reconstruction showed improved quality-adjusted life years at a lower cost compared with rehabilitation.

This higher-level evidence now assists surgeons in preoperative discussions with patients to give insight about their prognosis, treatment options, and lifestyle choices that affect the knee. These data have also been practice-changing in that the use of allografts in young athletes is now avoided for their ligament reconstructions. Preoperative patient demographics have been evaluated to give insight to patient outcomes, particularly obesity and body weight, with the goal to improve ACL reconstruction outcomes by altering these modifiable predictors of worse outcomes.

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