Journal article
Successful Medial Meniscal Repair Reduces Knee Pain 10 Years After Anterior Cruciate Ligament Reconstruction: Exploring the Consequences of Subsequent Surgery With Causal Mediation Analysis in the MOON Cohort
The American journal of sports medicine, Vol.53(4), pp.769-776
03/2025
DOI: 10.1177/03635465251317742
PMID: 39939845
Abstract
Medial meniscal repair performed at the time of primary anterior cruciate ligament reconstruction (ACLR) has been shown to be significantly associated with subsequent surgery, and subsequent surgery has been associated with increased Knee injury and Osteoarthritis Outcome Score (KOOS) pain score and decreased patient satisfaction.
The purpose was to determine if medial meniscal repair decreases KOOS pain 10 years after ACLR and to assess the consequences of subsequent surgery on the development of KOOS pain. The authors hypothesized that medial meniscal repair performed at the time of primary ACLR decreases the likelihood of developing KOOS pain. It was further hypothesized that surgery performed subsequent to medial meniscal repair and primary ACLR increases KOOS pain 10 years after ACLR.
Cohort study; Level of evidence, 2.
Our inclusion criteria were all patients undergoing unilateral primary ACLR from 2002 to 2008 who were enrolled in the Multicenter Orthopaedic Outcomes Network without a history of medial or lateral meniscal surgery and contralateral ACLR. Causal mediation analysis using R software (Version 4.2.3) was employed to compare 2 effects on the development of significant knee pain, as represented by a KOOS pain score <80, at 10-year follow-up: (1) medial meniscal repair for longitudinal tears >10 mm in medial-to-lateral length and (2) medial meniscal excision at baseline of ACLR. A directed acyclic graph was constructed to provide a qualitative representation of the influence of known confounders that have been shown to affect the outcome of interest. Missing data were multiply imputed using multivariate imputation by chained equations. All tests were 2-sided, assuming a type I error rate of .05.
In total, 2387 participants (1074 female [45%]; 1313 male [55%]) were included in the final analysis. In 1502 (62.9%) cases, there was no medial meniscal tear reported. Of the 885 cases with medial meniscal tears, no treatment was performed in 109 (12.4%), meniscal excision was performed in 396 (44.7%), and meniscal repair was performed in 380 (42.9%). An overall 1825 of 2387 (76.5%) patients reported KOOS pain at 10-year follow-up: 252 (13.8%) had KOOS pain <80 and 1573 had ≥80. In the KOOS pain <80 group, 75 (29.8%) had subsequent surgery. In the KOOS pain ≥80 group, 223 (14.2%) had subsequent surgery. The step-by-step approach to causal mediation analysis demonstrated that a medial meniscal procedure (ie, no treatment for the tear, repair, or excision) significantly affected the likelihood of subsequent surgery (χ
= 28.9;
< .001) and subsequent surgery significantly increased the likelihood of KOOS pain <80 (χ
= 17.3;
< .001). However, the direct effect of a successful medial meniscal repair without subsequent surgery decreased the likelihood of KOOS pain <80 by 7.1% when compared with medial meniscal excision (95% CI, -13.3% to -1%;
= .024). When subsequent surgery was performed after medial meniscal repair and ACLR, the likelihood of KOOS pain <80 increased by 2.9% (95% CI, 1.1%-5.3%;
< .001.).
Successful medial meniscal repair performed at the time of primary ACLR decreased clinically significant knee pain 10 years postoperatively. However, the mediating effect of subsequent surgery was significant and diminished the overall contribution of medial meniscal repair in decreasing the likelihood of KOOS pain. Continued efforts should be made to decrease the likelihood of subsequent surgery after medial meniscal repair performed at the time of primary ACLR.
Details
- Title: Subtitle
- Successful Medial Meniscal Repair Reduces Knee Pain 10 Years After Anterior Cruciate Ligament Reconstruction: Exploring the Consequences of Subsequent Surgery With Causal Mediation Analysis in the MOON Cohort
- Creators
- Andrew J Sheean - Brooke Army Medical CenterYuxuan Jin - Cleveland ClinicAnnunziato Amendola - Duke UniversityLaura J Huston - Vanderbilt University Medical CenterRobert H Brophy - Washington University in St. LouisCharles L Cox - Vanderbilt UniversityDavid C Flanigan - The Ohio State UniversityMorgan H Jones - Brigham and Women's HospitalChristopher C Kaeding - The Ohio State UniversityMichael W Kattan - Cleveland ClinicRobert A Magnussen - The Ohio State UniversityRobert G Marx - Hospital for Special SurgeryMatthew J Matava - Washington University in St. LouisEric C McCarty - University of Colorado BoulderRichard D Parker - Cleveland ClinicEmily Reinke - Duke UniversityMichelle L Wolcott - University of Colorado BoulderBrian R Wolf - University of IowaRick W Wright - Vanderbilt University Medical CenterKurt P Spindler - Cleveland Clinic
- Resource Type
- Journal article
- Publication Details
- The American journal of sports medicine, Vol.53(4), pp.769-776
- DOI
- 10.1177/03635465251317742
- PMID
- 39939845
- NLM abbreviation
- Am J Sports Med
- ISSN
- 1552-3365
- eISSN
- 1552-3365
- Publisher
- SAGE PUBLICATIONS INC
- Grant note
- National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: R01AR053684
One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award R01AR053684 (K.P.S.). R.H.B. has received support for education from Elite Orthopaedics. M.H.J. has received consulting fees from Regeneron Pharmaceuticals. C.C.K. has received consulting fees from Arthrex and Bioventus, support for education from CDC Medical, research support from DJO, honoraria from NovoPedics, and speaking fees from Smith & Nephew. R.G.M. has received royalties from Demos Health and Spring and holds stock options in MEND Nutrition. M.J.M. has received con- sulting fees from Arthrex, Breg, Heron Therapeutics, and Schwartz Biomedical and support for education from Elite Orthopaedics and Smith & Nephew. E.C.M. has received consulting fees from DePuy Synthes, Flexion Therapeutics, Medical Device Business Services, Pacira Therapeutics, and Zimmer Bio- met; royalties from Zimmer Biomet and Elsevier; speaking fees from Arthrex; and support for education from Gemini Mountain Medical. A.J.S. has received support for education from Arthrex, Medinc of Texas, Mid-Atlantic Surgical Systems, and Smith & Nephew; research funding from Arthrex; and consulting fees from Stryker Endoscopy. A.J.S. also holds stock options in Springbok Analytics. K.P.S. has received research funding from DonJoy Orthopedics, Med- ical Device Business Services, and Smith & Nephew; consulting fees from Flexion Therapeutics, National Football League, and NovoPedics; and royalties from Oberd. M.L.W. has received support for education from Gemini Mountain Medical. B.R.W. has received research funding from the Arthritis Foundation and consulting fees and royalties from Linvatec Corporation. R.W.W. has received royalties from Responsive Arthroscopy, MiCare, and Wolters Kluwer and holds stock options in Hyalex.AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
- Language
- English
- Electronic publication date
- 02/12/2025
- Date published
- 03/2025
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984790971502771
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