Predicting ACL Reconstruction Failure with Machine Learning: Development of Machine Learning Prediction Models.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-03-25 eCollection Date: 2025-03-01 DOI:10.1177/23259671251324519
Rafael Krasic Alaiti, Caio Sain Vallio, Andre Giardino Moreira da Silva, Riccardo Gomes Gobbi, José Ricardo Pécora, Camilo Partezani Helito
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引用次数: 0

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) is the predominant and widely accepted treatment modality for ACL injury. However, recurrence of ACL rupture or failure of the reconstruction remains a significant challenge. Despite several studies in the literature that have developed prediction models to address this issue by identifying prognostic factors for treatment outcomes using classical statistical methods, the predictive efficacy of these models is frequently suboptimal.

Purpose: To (1) evaluate the predictive performance of different machine learning algorithms for the occurrence of failure in ACLR and (2) identify the most relevant predictors associated with this outcome.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 680 patients who underwent ACLR between January 2012 and July 2021 were evaluated. The study outcome was ACLR failure-defined as a complete tear confirmed by magnetic resonance imaging, arthroscopy, or clinical ACL insufficiency-evaluated at a minimum 2-year follow-up. Routinely collected data were used to train 9 machine learning algorithms-including k-nearest neighbors classifier, decision tree classifier, random forest classifier, extra trees classifier, gradient boosting classifier, eXtreme Gradient Boosting, CatBoost classifier, and logistic regression. A random sample of 70% of patients was used to train the algorithms, and 30% were left for performance assessment, simulating new data. The performance of the models was evaluated with the area under the receiver operating characteristic curve (AUC).

Results: The predictive performance of most models was good, with AUCs ranging from 0.71 to 0.85. The models with the best AUC metric were the CatBoost classifier (0.85 [95% CI, 0.81-0.89]) and the random forest classifier (0.84 [95% CI, 0.77-0.90). Knee hyperextension consistently emerged as the primary predictor for ACLR failure across all models subjected to our analysis.

Conclusion: Machine learning algorithms demonstrated good performance in predicting ACLR failure. Moreover, knee hyperextension consistently emerged as the primary predictor for failure across all models subjected to our analysis.

Clinical relevance: The findings of this study highlight the potential of machine learning as a valuable clinical tool for decision-making on surgical intervention. By offering nuanced insights, these algorithms may contribute to the evolving landscape of orthopaedic practice. Also, this study confirms knee hyperextension as an important risk factor for ACLR failure.

用机器学习预测ACL重建失败:机器学习预测模型的发展。
背景:前交叉韧带重建(ACLR)是前交叉韧带损伤的主要和广泛接受的治疗方式。然而,前交叉韧带断裂或重建失败的复发仍然是一个重大的挑战。尽管文献中的一些研究已经开发了预测模型,通过使用经典统计方法识别治疗结果的预后因素来解决这一问题,但这些模型的预测效果往往不是最理想的。目的:(1)评估不同机器学习算法对ACLR故障发生的预测性能,(2)确定与该结果相关的最相关预测因子。研究设计:队列研究;证据水平,3。方法:对2012年1月至2021年7月期间接受ACLR的680例患者进行评估。研究结果为ACLR失败,定义为磁共振成像、关节镜检查或临床ACL功能不全,随访至少2年。使用常规收集的数据训练9种机器学习算法,包括k近邻分类器、决策树分类器、随机森林分类器、额外树分类器、梯度增强分类器、极端梯度增强分类器、CatBoost分类器和逻辑回归。随机抽取70%的患者样本用于训练算法,30%用于性能评估,模拟新数据。用接收机工作特性曲线下面积(AUC)来评价模型的性能。结果:大多数模型的预测性能较好,auc范围在0.71 ~ 0.85之间。具有最佳AUC度量的模型是CatBoost分类器(0.85 [95% CI, 0.81-0.89])和随机森林分类器(0.84 [95% CI, 0.77-0.90])。在我们分析的所有模型中,膝关节过伸一直是ACLR失败的主要预测因素。结论:机器学习算法在预测ACLR故障方面表现良好。此外,在我们分析的所有模型中,膝关节过伸一直是失败的主要预测因素。临床相关性:本研究的发现强调了机器学习作为外科干预决策的有价值的临床工具的潜力。通过提供细致入微的见解,这些算法可能有助于骨科实践的不断发展。此外,本研究证实膝关节过伸是ACLR失败的重要危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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