Journal article
Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study
The American journal of sports medicine, Vol.51(3), pp.605-614
03/2023
DOI: 10.1177/03635465231151389
PMCID: PMC10338044
PMID: 36734487
Abstract
Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction.
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.
Cohort study; Level of evidence, 3.
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.
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.
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.
Details
- Title: Subtitle
- Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study
- Creators
- Rick W Wright - Vanderbilt UniversityBrian R Wolf - University of IowaLaura J Huston - Vanderbilt UniversityAmanda K Haas - Washington University in St. LouisJacquelyn S Pennings - Vanderbilt UniversityChristina R Allen - Yale UniversityDaniel E Cooper - WB Carrell Memorial Clinic, Dallas, Texas, USA.Thomas M DeBerardino - The San Antonio Orthopaedic Group, San Antonio, Texas, USA.Warren R Dunn - Texas Orthopedic HospitalBrett Brick A Lantz - Slocum Research and Education FoundationKurt P Spindler - Cleveland ClinicMichael J Stuart - Mayo ClinicJohn P Albright - University of IowaAnnunziato Ned Amendola - Duke UniversityJack T Andrish - Cleveland ClinicChristopher C Annunziata - Virginia Commonwealth UniversityRobert A Arciero - UConn HealthBernard R Bach Jr - Rush University Medical CenterChamp L Baker III - Hughston ClinicArthur R Bartolozzi - University of Pennsylvania Health SystemKeith M Baumgarten - Orthopedic InstituteJeffery R Bechler - University Orthopaedic AssociatesJeffrey H Berg - Orthopaedic CenterGeoffrey A Bernas - University at Buffalo, State University of New YorkStephen F Brockmeier - University of VirginiaRobert H Brophy - Washington University in St. LouisCharles A Bush-Joseph - Rush University Medical CenterJ Brad Butler V - Orthopedic and Fracture Clinic, Portland, Oregon, USAJohn D Campbell - Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA.James L Carey - University of PennsylvaniaJames E Carpenter - University of MichiganBrian J Cole - Rush University Medical CenterJonathan M Cooper - HealthPartnersCharles L Cox - Vanderbilt UniversityR Alexander Creighton - University of North Carolina at Chapel HillDiane L Dahm - Mayo Clinic in FloridaTal S David - Moscow University «Synergy»David C Flanigan - The Ohio State UniversityRobert W Frederick - Rothman InstituteTheodore J Ganley - Children's Hospital of PhiladelphiaElizabeth A Garofoli - Washington University in St. LouisCharles J Gatt Jr - University Orthopaedic AssociatesSteven R Gecha - Princeton UniversityJames Robert Giffin - Fowler Kennedy Sport Medicine ClinicSharon L Hame - University of California, Los AngelesJo A Hannafin - Hospital for Special SurgeryChristopher D Harner - The University of Texas Health Science Center at HoustonNorman Lindsay Harris Jr - Grand River Health, Rifle, Colorado, USAKeith S Hechtman - UHZ Sports Medicine Institute, Coral Gables, Florida, USA.Elliott B Hershman - Lenox Hill HospitalRudolf G Hoellrich - Slocum Research and Education FoundationDavid C Johnson - Charlotte Sports Medicine InstituteTimothy S Johnson - Charlotte Sports Medicine InstituteMorgan H Jones - Cleveland ClinicChristopher C Kaeding - The Ohio State UniversityGanesh V Kamath - University of North Carolina at Chapel HillThomas E Klootwyk - Methodist Sports MedicineBruce A Levy - Mayo Clinic Rochester, Minnesota, USA.C Benjamin Ma - University of California, San FranciscoG Peter Maiers II - Methodist Sports MedicineRobert G Marx - Hospital for Special SurgeryMatthew J Matava - Washington University in St. LouisGregory M Mathien - Tennessee Orthopaedic ClinicsDavid R McAllister - University of California, Los AngelesEric C McCarty - University of Colorado DenverRobert G McCormack - Fraser HealthBruce S Miller - University of MichiganCarl W Nissen - Connecticut Children's Medical CenterDaniel F O'Neill - Regional HealthBrett D Owens - Brown UniversityRichard D Parker - Cleveland ClinicMark L Purnell - Aspen Orthopedic Associates, Aspen, Colorado, USA.Arun J Ramappa - Beth Israel Deaconess Medical CenterMichael A Rauh - University at Buffalo, State University of New YorkArthur C Rettig - Methodist Sports MedicineJon K Sekiya - University of MichiganKevin G Shea - Intermountain HealthcareOrrin H Sherman - New York University Langone Orthopedic HospitalJames R Slauterbeck - University of South AlabamaMatthew V Smith - Washington University in St. LouisJeffrey T Spang - University of North Carolina at Chapel HillLtc Steven J Svoboda - Keller Army Community HospitalTimothy N Taft - University of North Carolina at Chapel HillJoachim J Tenuta - Albany Medical Center HospitalEdwin M Tingstad - Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.Armando F Vidal - University of Colorado DenverDarius G Viskontas - Royal Columbian HospitalRichard A White - Fitzgibbon HospitalJames S Williams Jr - Cleveland ClinicMichelle L Wolcott - University of Colorado DenverJames J York - Orthopaedic CenterMARS Group
- Resource Type
- Journal article
- Publication Details
- The American journal of sports medicine, Vol.51(3), pp.605-614
- DOI
- 10.1177/03635465231151389
- PMID
- 36734487
- PMCID
- PMC10338044
- NLM abbreviation
- Am J Sports Med
- ISSN
- 0363-5465
- eISSN
- 1552-3365
- Grant note
- DOI: 10.13039/100000069, name: National Institute of Arthritis and Musculoskeletal and Skin Diseases, award: 5R01-AR060846
- Language
- English
- Electronic publication date
- 02/03/2023
- Date published
- 03/2023
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984364759902771
Metrics
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