Natural corollaries and recovery after acute Anterior Cruciate Ligament (ACL) injury – the NACOX cohort study protocol

Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life, and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood.

Overall aim of the NACOX study is to investigate the natural corollaries and recovery after an ACL injury.

There are five main study objectives:

  1. To assess biological, psychological and social factors and their relationships to the natural corollaries and recovery after acute ACL injury
  2. To evaluate the choice of treatment after acute ACL-injury (i.e. ACL reconstruction, ACLR or non-ACL reconstruction, non-ACLR)
  3. To evaluate the return to sport after acute ACL injury
  4. To study knee problems in the short and long term after acute ACL-injury
  5. To identify proxies (biomarkers and structural risk factors) for early detection of symptomatic and radiographic osteoarthritis

This is a multi-centre prospective prognostic cohort study of patients with acute ACL injury. At 7 sites in Sweden, patients aged 15-40 years are included within 6 weeks after primary ACL injury. Patients complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 131 patients are followed with clinical examinations, several imaging modalities, and biological samples.

The last patient was included 15th October 2019. In total, 142 patients have been included from Linköping and 136 from the other sites together.

Research group
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External Co-investigators

  • Håkan Gauffin, MD, PhD, Department of Orthopaedics, Linköping University, Linköping, Sweden
  • Richard Frobell, PhD, Associate Professor, Orthopedics, Clinical Sciences Lund, Lund University, Sweden
  • Anders Stålman, MD PhD, Capio ArtroClinic, Stockholm Sports Trauma Research Center, Sophiahemmet, Stockholm

Collaborators

External Collaborators

  • Michael A Bowes, Sr Director Clinical Applications, Imorphics Ltd, Manchester, UK
  • Ann-Sofi Björkman, MD Center for Medical Image Science and Visualization (CMIV), Department of Radiology, Linköping University, Sweden
  • Victor Casula, PhD, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland
  • Maria Lindblom, MD Center for Medical Image Science and Visualization (CMIV), Department of Radiology, Linköping University, Sweden
  • Anne Fältström, Physiotherapist, PhD, Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping
  • Seppo Koskinen, Professor in Medical Radiology at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet
  • Miika Nieminen, Professor, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Finland

Financial support

  • The Swedish Research Council
  • The Swedish Research Council for Sport Science
  • The Medical Research Council of Southeast Sweden (FORSS)

Organisation
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