Skip to main content

Master of Public Health

Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

AUTHORS

, Wright RW , Huston LJ , Haas AK , Pennings JS , Allen CR , Cooper DE , DeBerardino TM , Dunn WR , Lantz BBA , Spindler KP , Stuart MJ , Albright JP , Amendola AN , Andrish JT , Annunziata CC , Arciero RA , Bach BR , Baker CL , Bartolozzi AR , Baumgarten KM , Bechler JR , Berg JH , Bernas GA , Brockmeier SF , Brophy RH , Bush-Joseph CA , Butler JB , Campbell JD , Carey JL , Carpenter JE , Cole BJ , Cooper JM , Cox CL , Creighton RA , Dahm DL , David TS , Flanigan DC , Frederick RW , Ganley TJ , Garofoli EA , Gatt CJ , Gecha SR , Giffin JR , Hame SL , Hannafin JA , Harner CD , Harris NL , Hechtman KS , Hershman EB , Hoellrich RG , Johnson DC , Johnson TS , Jones MH , Kaeding CC , Kamath GV , Klootwyk TE , Levy BA , Ma CB , Maiers GP , Marx RG , Matava MJ , Mathien GM , McAllister DR , McCarty EC , McCormack RG , Miller BS , Nissen CW , O'Neill DF , Owens BD , Parker RD , Purnell ML , Ramappa AJ , Rauh MA , Rettig AC , Sekiya JK , Shea KG , Sherman OH , Slauterbeck JR , Smith MV , Spang JT , Svoboda LSJ , Taft TN , Tenuta JJ , Tingstad EM , Vidal AF , Viskontas DG , White RA , Williams JS , Wolcott ML , Wolf BR , York JJ , . The American journal of sports medicine. 2023 2 3; (). 3635465231151389

ABSTRACT

BACKGROUND: Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction.

PURPOSE: To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient’s outcome at 6-year follow-up.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction.

RESULTS: An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; ≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation ( < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores ( < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years.

CONCLUSION: Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.

Tags: