Rick Wright, M.D., executive vice chairman of the Department of Orthopaedic Surgery at Washington University in St. Louis, Missouri has been honored with the 2019 Kappa Delta Ann Doner Vaughn Award, along with his colleagues in the MARS (Multicenter Anterior Cruciate Ligament Revision Study) Group.
Rick Wright, M.D. Receives Kappa Delta Award for ACL Research
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Dr. Wright, the current president of the American Orthopaedic Association, accepted the honor at this year’s annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) for his research studying revision anterior cruciate ligament (ACL) reconstruction and the factors which contribute to poor outcomes.
Wright’s team organized a multicenter, multi-surgeon group (MARS Group) from the American Orthopaedic Society for Sports Medicine (AOSSM) membership. The group, which consisted of 83 members at 52 sites, was an approximate 50/50 mix of academic and private practice surgeons. The study enrolled 1,234 patients. The study’s follow-up rate was nearly unheard of—greater than 99%.
“Allograft had been used in people who were less active and, on average, four years older,” said Dr. Wright. “The allografts were failing in an older less active population still at a rate higher. At six years, the increase jumps to six times more common to fail with an allograft. In general, it likely holds true that in younger, more active patients in the revision setting, allografts fail more commonly.”
Dr. Wright told OTW, “I think this award honors the efforts of a large group of surgeons and coordinators that came together to collectively address a significantly challenging problem in orthopaedic sports medicine—the worst results seen in revision ACL reconstruction outcomes. It demonstrates the quality of the research that can be done in what is a relatively low frequency procedure for any single surgeon when a group works together.”
“An important issue for revision ACL reconstruction is the graft choice in the revision setting.”
“We were uncertain about what grafts would work best. To standardize the study, we required all surgeons utilizing an allograft to use the same source so that we would know the demographics and processing for every allograft utilized.”
“At 2 years allograft was shown to fail at a higher rate (odds ratio 2.78). At longer follow up of 6 years we found the risk for allograft re-rupture had risen (odds Ratio 6.1). Based on these findings it appears that when able, surgeons should utilize an autograft to decrease the graft re-rupture rate.”
This is Dr. Wright’s second time being honored with the Kappa Delta Ann Doner Vaughan Award. He previously won the award in 2012 for his research on the prognosis and predictors of ACL reconstruction.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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