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dc.contributor.authorMartin, Richard Kyle
dc.contributor.authorWastvedt, Solvejg
dc.contributor.authorPareek, Ayoosh
dc.contributor.authorPersson, Andreas
dc.contributor.authorVisnes, Håvard
dc.contributor.authorFenstad, Anne Marie
dc.contributor.authorMoatshe, Gilbert
dc.contributor.authorWolfson, Julian
dc.contributor.authorLind, Martin
dc.contributor.authorEngebretsen, Lars
dc.date.accessioned2022-04-21T11:40:35Z
dc.date.available2022-04-21T11:40:35Z
dc.date.created2022-03-23T07:47:09Z
dc.date.issued2022
dc.identifier.citationKnee Surgery, Sports Traumatology, Arthroscopy. 2022, 30(2), Side 368-375.en_US
dc.identifier.issn0942-2056
dc.identifier.urihttps://hdl.handle.net/11250/2991978
dc.descriptionThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.en_US
dc.description.abstractPurpose: External validation of machine learning predictive models is achieved through evaluation of model performance on different groups of patients than were used for algorithm development. This important step is uncommonly performed, inhibiting clinical translation of newly developed models. Machine learning analysis of the Norwegian Knee Ligament Register (NKLR) recently led to the development of a tool capable of estimating the risk of anterior cruciate ligament (ACL) revision (https://swastvedt.shinyapps.io/calculator_rev/). The purpose of this study was to determine the external validity of the NKLR model by assessing algorithm performance when applied to patients from the Danish Knee Ligament Registry (DKLR). Methods: The primary outcome measure of the NKLR model was probability of revision ACL reconstruction within 1, 2, and/or 5 years. For external validation, all DKLR patients with complete data for the five variables required for NKLR prediction were included. The five variables included graft choice, femur fixation device, KOOS QOL score at surgery, years from injury to surgery, and age at surgery. Predicted revision probabilities were calculated for all DKLR patients. The model performance was assessed using the same metrics as the NKLR study: concordance and calibration. Results: In total, 10,922 DKLR patients were included for analysis. Average follow-up time or time-to-revision was 8.4 (± 4.3) years and overall revision rate was 6.9%. Surgical technique trends (i.e., graft choice and fixation devices) and injury characteristics (i.e., concomitant meniscus and cartilage pathology) were dissimilar between registries. The model produced similar concordance when applied to the DKLR population compared to the original NKLR test data (DKLR: 0.68; NKLR: 0.68–0.69). Calibration was poorer for the DKLR population at one and five years post primary surgery but similar to the NKLR at two years. Conclusion: The NKLR machine learning algorithm demonstrated similar performance when applied to patients from the DKLR, suggesting that it is valid for application outside of the initial patient population. This represents the first machine learning model for predicting revision ACL reconstruction that has been externally validated. Clinicians can use this in-clinic calculator to estimate revision risk at a patient specific level when discussing outcome expectations pre-operatively. While encouraging, it should be noted that the performance of the model on patients undergoing ACL reconstruction outside of Scandinavia remains unknown. Level of evidence: III.en_US
dc.language.isoengen_US
dc.subjectACL reconstructionen_US
dc.subjectACL revisionen_US
dc.subjectartificial intelligenceen_US
dc.subjectmachine learningen_US
dc.subjectoutcome predictionen_US
dc.titleMachine learning algorithm to predict anterior cruciate ligament revision demonstrates external validityen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.rights.holder© The Author(s) 2021en_US
dc.source.pagenumber368-375en_US
dc.source.volume30en_US
dc.source.journalKnee Surgery, Sports Traumatology, Arthroscopyen_US
dc.source.issue2en_US
dc.identifier.doi10.1007/s00167-021-06828-w
dc.identifier.cristin2011837
dc.description.localcodeInstitutt for idrettsmedisinske fag / Department of Sports Medicineen_US
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1


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