A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort.
| Title: | A Novel Machine Learning Model to Predict Revision ACL Reconstruction Failure in the MARS Cohort. |
|---|---|
| Authors: | Vasavada K; Yale University, New Haven, Connecticut, USA.; Vasavada V; NYU Hospital for Joint Diseases, New York, New York, USA.; Moran J; Yale University, New Haven, Connecticut, USA.; Devana S; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.; Lee C; Korea University, Seoul, Republic of Korea.; Hame SL; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.; Jazrawi LM; NYU Hospital for Joint Diseases, New York, New York, USA.; Sherman OH; NYU Hospital for Joint Diseases, New York, New York, USA.; Huston LJ; Vanderbilt University, Nashville, Tennessee, USA.; Haas AK; Washington University in St Louis, St Louis, Missouri, USA.; Allen CR; Yale University, New Haven, Connecticut, USA.; Cooper DE; W.B. Carrell Memorial Clinic, Dallas, Texas, USA.; DeBerardino TM; UT Health, San Antonio, Texas, USA.; Spindler KP; Cleveland Clinic, Cleveland, Ohio, USA.; Stuart MJ; Mayo Clinic, Rochester, Minnesota, USA.; Ned Amendola A; Duke University, Durham, North Carolina, USA.; Annunziata CC; Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.; Arciero RA; University of Connecticut Health Center, Farmington, Connecticut, USA.; Bach BR Jr; Rush University Medical Center, Chicago, Illinois, USA.; Baker CL 3rd; The Hughston Clinic, Columbus, Georgia, USA.; Bartolozzi AR; 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.; Baumgarten KM; Orthopedic Institute, Sioux Falls, South Dakota, USA.; Berg JH; Town Center Orthopaedic Associates, Reston, Virginia, USA.; Bernas GA; State University of New York at Buffalo, Buffalo, New York, USA.; Brockmeier SF; University of Virginia, Charlottesville, Virginia, USA.; Brophy RH; Washington University in St Louis, St Louis, Missouri, USA.; Bush-Joseph CA; Rush University Medical Center, Chicago, Illinois, USA.; Butler V JB; Orthopedic and Fracture Clinic, Portland, Oregon, USA.; Carey JL; University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Carpenter JE; University of Michigan, Ann Arbor, Michigan, USA.; Cole BJ; Rush University Medical Center, Chicago, Illinois, USA.; Cooper JM; HealthPartners Specialty Center, St Paul, Minnesota, USA.; Cox CL; Vanderbilt University, Nashville, Tennessee, USA.; Creighton RA; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; David TS; Synergy Specialists Medical Group, San Diego, California, USA.; Dunn WR; Fondren Orthopedic Group, Houston, Texas, USA.; Flanigan DC; The Ohio State University, Columbus, Ohio, USA.; Frederick RW; The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.; Ganley TJ; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Gatt CJ Jr; University Orthopaedic Associates LLC, Princeton, New Jersey, USA.; Gecha SR; Princeton Orthopaedic Associates, Princeton, New Jersey, USA.; Giffin JR; Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.; Hannafin JA; Hospital for Special Surgery, New York, New York, USA.; Lindsay Harris N Jr; Grand River Health, Rifle, Colorado, USA.; Hechtman KS; Miami Orthopedics and Sports Medicine Institute, Coral Gables, Florida, USA.; Hershman EB; Lenox Hill Hospital, New York, New York, USA.; Hoellrich RG; Slocum Research and Education Foundation, Eugene, Oregon, USA.; Johnson DC; National Sports Medicine Institute, Leesburg, Virginia, USA.; Johnson TS; National Sports Medicine Institute, Leesburg, Virginia, USA.; Jones MH; Brigham and Women's Hospital, Boston, Massachusetts, USA.; Kaeding CC; The Ohio State University, Columbus, Ohio, USA.; Kamath GV; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Klootwyk TE; Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.; Levy BA; Orlando Health, Orlando, Florida, USA.; Ma CB; University of California at San Francisco, San Francisco, California, USA.; Maiers GP 2nd; Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.; Marx RG; Hospital for Special Surgery, New York, New York, USA.; Matava MJ; Washington University in St Louis, St Louis, Missouri, USA.; Mathien GM; Knoxville Orthopedic Clinic, Knoxville, Tennessee, USA.; McAllister DR; University of California at Los Angeles, Los Angeles, California, USA.; McCarty EC; University of Colorado-Denver School of Medicine, Denver, Colorado, USA.; McCormack RG; University of British Columbia/Fraser Health Authority, New Westinster, British Columbia, Canada.; Miller BS; University of Michigan, Ann Arbor, Michigan, USA.; Nissen CW; Connecticut Children's Medical Center, Hartford, Connecticut, USA.; O'Neill DF; The Alpine Clinic, Plymouth, New Hampshire, USA.; Owens BD; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.; Parker RD; Cleveland Clinic, Cleveland, Ohio, USA.; Purnell ML; Valley Ortho, Aspen, Colorado, USA.; Ramappa AJ; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Rauh MA; State University of New York at Buffalo, Buffalo, New York, USA.; Rettig AC; Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.; Sekiya JK; University of Michigan, Ann Arbor, Michigan, USA.; Shea KG; Stanford University, Palo Alto, California, USA.; Slauterbeck JR; UNC Health Southeastern, Lumberton, North Carolina, USA.; Smith MV; Washington University in St Louis, St Louis, Missouri, USA.; Spang JT; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Svoboda SJ; MedStar Orthopaedic and Sports Center, Washington, DC, USA.; Taft TN; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Tenuta JJ; Albany Medical Center, Albany, New York, USA.; Tingstad EM; Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.; Vidal AF; The Steadman Clinic, Vail, Colorado, USA.; Viskontas DG; Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada.; White RA; Fitzgibbon's Hospital, Marshall, Missouri, USA.; Williams JS Jr; Cleveland Clinic, Euclid, Ohio, USA.; Wolcott ML; University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA.; Wolf BR; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.; Wright RW; Vanderbilt University, Nashville, Tennessee, USA.; York JJ; Luminis Health Orthopedics, Pasadena, Maryland, USA. |
| Corporate Authors: | MARS Group |
| Source: | Orthopaedic journal of sports medicine [Orthop J Sports Med] 2024 Nov 14; Vol. 12 (11), pp. 23259671241291920. Date of Electronic Publication: 2024 Nov 14 (Print Publication: 2024). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Sage on behalf of: The American Orthopaedic Society for Sports Medicine Country of Publication: United States NLM ID: 101620522 Publication Model: eCollection Cited Medium: Print ISSN: 2325-9671 (Print) Linking ISSN: 23259671 NLM ISO Abbreviation: Orthop J Sports Med Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Thousand Oaks, CA] : Sage on behalf of: The American Orthopaedic Society for Sports Medicine, [2013]- |
| 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).; (© The Author(s) 2024.) |
| Competing Interests: | 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. |
| References: | Ann Surg. 2018 Jul;268(1):70-76. (PMID: 29389679); J Arthroplasty. 2021 May;36(5):1655-1662.e1. (PMID: 33478891); Arthroscopy. 1995 Apr;11(2):151-6. (PMID: 7794426); Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):2958-2966. (PMID: 33047150); Arthroscopy. 2007 Nov;23(11):1218-25. (PMID: 17986410); Am J Sports Med. 2013 Jul;41(7):1571-8. (PMID: 23698386); Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):368-375. (PMID: 34973096); Am J Sports Med. 2018 Oct;46(12):2836-2841. (PMID: 29882693); J Bone Joint Surg Am. 2012 Mar 21;94(6):531-6. (PMID: 22438002); Clin Sports Med. 1999 Jan;18(1):109-71. (PMID: 10028120); Knee Surg Sports Traumatol Arthrosc. 2012 Jul;20(7):1298-306. (PMID: 22159522); Knee Surg Sports Traumatol Arthrosc. 2011 Feb;19(2):196-201. (PMID: 20644911); Orthop J Sports Med. 2021 Oct 14;9(10):23259671211046575. (PMID: 34671691); Orthop J Sports Med. 2018 Jan 24;6(1):2325967117751689. (PMID: 29399591); J Knee Surg. 2012 Nov;25(5):361-8. (PMID: 23150344); Arthroplast Today. 2021 Aug 02;10:135-143. (PMID: 34401416); Am J Sports Med. 1991 May-Jun;19(3):276-82. (PMID: 1867335); Arthroscopy. 1996 Apr;12(2):160-4. (PMID: 8776992); Am J Sports Med. 2015 Jul;43(7):1583-90. (PMID: 25899429); J Bone Joint Surg Am. 2011 Jun 15;93(12):1159-65. (PMID: 21776554); J Bone Joint Surg Am. 2022 Jan 19;104(2):145-153. (PMID: 34662318); Knee. 2004 Feb;11(1):29-36. (PMID: 14967325); JAMA. 2018 Apr 3;319(13):1317-1318. (PMID: 29532063); Intensive Care Med. 2003 Jul;29(7):1043-51. (PMID: 12734652); Am J Sports Med. 2007 Jul;35(7):1131-4. (PMID: 17452511); Am J Sports Med. 2023 Feb;51(2):545-556. (PMID: 34766840); Am J Sports Med. 2009 Apr;37(4):683-7. (PMID: 19204364); Am J Sports Med. 2011 Feb;39(2):366-73. (PMID: 21173195); Nature. 2020 Sep;585(7825):357-362. (PMID: 32939066); Am J Sports Med. 2006 Dec;34(12):2026-37. (PMID: 17092921); N Engl J Med. 2008 Nov 13;359(20):2135-42. (PMID: 19005197); J Am Acad Orthop Surg. 2021 Mar 15;29(6):235-243. (PMID: 33323681); Am J Sports Med. 2021 Aug;49(10):2589-2598. (PMID: 34260326); Orthopedics. 2007 Mar;30(3):206-9. (PMID: 17375546); Clin Orthop Relat Res. 1992 Oct;(283):187-95. (PMID: 1395244); J ISAKOS. 2022 Jun;7(3):1-9. (PMID: 36178391); Am J Sports Med. 2014 Oct;42(10):2301-10. (PMID: 25274353); J Knee Surg. 2013 Aug;26(4):239-47. (PMID: 23404491); Arthroscopy. 2022 Jun;38(6):2090-2105. (PMID: 34968653); Instr Course Lect. 2001;50:463-74. (PMID: 11372347); Curr Rev Musculoskelet Med. 2022 Dec;15(6):645-650. (PMID: 36242754); Am J Sports Med. 2010 Oct;38(10):1979-86. (PMID: 20889962); Eur Spine J. 2022 Aug;31(8):1952-1959. (PMID: 34392418) |
| Grant Information: | R01 AR060846 United States AR NIAMS NIH HHS |
| Contributed Indexing: | Keywords: ACL revision; femoral tunnel; graft failure; machine learning; tibial tunnel |
| Molecular Sequence: | ClinicalTrials.gov NCT00625885 |
| Entry Date(s): | Date Created: 20241118 Latest Revision: 20260302 |
| Update Code: | 20260302 |
| PubMed Central ID: | PMC11565622 |
| DOI: | 10.1177/23259671241291920 |
| PMID: | 39555321 |
| Database: | MEDLINE |
Journal Article