MOON’s Strategy for Obtaining Over Eighty Percent Follow-up at 10 Years Following ACL Reconstruction

Abstract

The Multicenter Orthopaedic Outcomes Network (MOON) study of anterior cruciate ligament (ACL) reconstruction has achieved >80% follow-up for study subjects who were enrolled from 2002 to 2005; patient-reported outcome measures (PROMs) were reported at 2, 6, and 10 years through a carefully designed protocol that included surgeon involvement to encourage subjects to complete and return questionnaires. The process included emails and telephone calls from the central coordinating center, from research coordinators at each local institution, and lastly, from the subjects' surgeons for those who were less inclined to complete the follow-up. In order to quantify the effect of site and surgeon involvement, the enrollment year of 2005 was monitored for the 10-year follow-up (n = 516 subjects). In contact efforts made by the coordinating center, 73.8% (381) of study subjects were reached by the central site coordinator, contact information was verified, and questionnaires were subsequently sent, completed, and returned. An additional 54 subjects (10.5% of the overall study population) returned the questionnaire after local study site involvement, indicating the importance of individual surgeon and local site involvement to improve follow-up rates in multicenter studies in orthopaedic surgery. Follow-up rates were higher when a specific individual (the surgeon or the research coordinator) was given the task of final follow-up.Achieving high rates of long-term follow-up in orthopaedic studies has proven to be challenging, with follow-up of approximately 80% required for Level-I evidence [1][2][3][4][5] . Achieving that rate of follow-up is even more difficult with young patients, who generally relocate more frequently than older patients [6][7][8] . Age is a proven risk factor for greater loss to follow-up in anterior cruciate ligament (ACL) reconstruction 6 . Our multi-center study of ACL reconstruction has achieved >80% followup with patient-reported outcome measures (PROMs) at 2, 6, and 10 years for study subjects who were enrolled from 2002 to 2005. This was accomplished through a carefully designed protocol that included surgeon involvement as a last resort to encourage subjects to complete and return questionnaires [9][10][11][12][13][14][15] . The process included emails and telephone calls from the *A list of the MOON Group members is included in a note at the end of the article.

Ten‐year results from the UK National Ligament Registry: Patient characteristics and factors predicting nonresponders for completion of outcome scores

“…Possible explanations may involve the associated time burden, particularly significant for ACLR patient cohorts who are typically young and busy. It is well recognised that lengthy questionnaires can lead to respondent fatigue, resulting in less thoughtful answers or premature termination of their participation [19,15,18,36]. Among national ligament registries, the NLR is unique in its collection of four subjective PROMs [11].…”

Predictors of Return to Activity at 2 Years After Anterior Cruciate Ligament Reconstruction Among Patients With High Preinjury Marx Activity Scores: A MOON Prospective Cohort Study

“…Although the Marx activity scale has been shown to be reliable with good concurrent and divergent validity, it is not without its own weaknesses. 20 For example, among patients recovering from ACLR, lower activity scores may be the consequence of life choices made because of a fear of reinjuries or an avoidance of future symptoms rather than specific symptoms related to pain, instability, and/or overall function. 8 Thus, decrements in activity levels relevant to baseline values may not be solely related to the variables of interest, which then has the potential to obscure the accuracy of predictive modeling.…”

“…Several previous studies published by the Multicenter Orthopaedic Outcomes Network (MOON) group have noted modest rates of return to preinjury activity levels that generally are not sustained over longer-term periods. 6,7,9,12 Of note, the MOON group has largely based its assessments of return to preinjury activity levels on changes in the Marx activity scale score, a tool that evaluates decelerating and pivoting activities during a patient’s “healthiest and most active state in the past year.” 20 Additionally, the instrument is designed to avoid ceiling effects, as a score of 12 to 16 generally denotes a high level of activity that would be typical of participation in competitive cutting- and pivoting-type sporting activities: for example, high school and collegiate sports. Based on a consensus opinion, a 2-point decrease in the preinjury versus postinjury score constitutes a substantial negative change that indicates an inability to return to preinjury function.…”

Clinical and Radiographic Assessment of Adult Function After Blount Disease in Childhood: An Exercise in Futility

“…What we learned the most from this study were the obstructions to conducting it. Although several authors have reported much higher response rate or made recommendations as to methods of contacting former patients, [11][12][13][14] those methods are either out of date or not applicable to the type of study we were trying to conduct. Current IRB and Health Insurance Portability and Accountability Act (HIPAA) patient-confidentiality requirements severely restrict recruitment efforts, particularly by phone.…”

“…The Authors of the Multicenter Orthopedic Outcomes Network (MOON) study 13 in 2021 reported successfully contacting 80% of a cohort of 516 patients 10 years after anterior cruciate ligament (ACL) reconstruction. They emphasized the importance of regular contact by a committed investigator making contact with the subjects, including the treating surgeon if necessary.…”