Citations 1
Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study
Group, The MARS, Wright, Rick W. , Haas, Amanda K. , Pennings, Jacquelyn S. , Cooper, Daniel E. , Dunn, Warren R. , Lantz, Brett A., Albright, John P., Amendola, Annunziato , Andrish, Jack T. , Annunziata, Christopher C., Arciero, Robert A. , Bach, Bernard R. , Baker, Champ L., Bartolozzi, Arthur R. , Baumgarten, Keith M. , Bechler, Jeffery R., Berg, Jeffrey H., Bernas, Geoffrey A., Brockmeier, Stephen F. , Bush‐Joseph, Charles A., Butler, J. Brad, Carey, James L. , Carpenter, James E. , Cole, Brian J. , Cooper, Jonathan M. , Cox, Charles L. , Creighton, R. Alexander , Dahm, Diane L., Flanigan, David C. , Frederick, Robert W., Ganley, Theodore J. , Garofoli, Elizabeth A. , Gatt, Charles J. , Gecha, Steven R., Hame, Sharon L. , Hannafin, Jo A., Harner, Christopher D. , Harris, Norman Lindsay, Hechtman, Keith S., Hershman, Elliott B., Hoellrich, Rudolf G., Johnson, David C. , Kaeding, Christopher C. , Kamath, Ganesh V. , Klootwyk, Thomas E., Levy, Bruce A. , Benjamin, C. , Maiers, G. Peter, Marx, Robert G. , Matava, Matthew J. , Mathien, Gregory M., McCarty, Eric C. , McCormack, Robert G. , Miller, Bruce S. , Nissen, Carl W. , O’Neill, Daniel F., Parker, Richard D., Purnell, Mark L., Ramappa, Arun J. , Rauh, Michael A. , Rettig, Arthur C., Sekiya, Jon K., Slauterbeck, James R., Smith, Matthew V. , Spang, Jeffrey T. , Svoboda, LTC Steven J., Taft, Timothy N., Tenuta, Joachim J., Tingstad, Edwin M., Vidal, Armando F. , Viskontas, Darius G., White, Richard A., Williams, James S., Wolcott, Michelle L., York, James J. , Svoboda, Steven J. , McCarty, Eric C , Group, The MARS, Huston, Laura J. , Allen, Christina R. , DeBerardino, Thomas M. , Spindler, Kurt P , Stuart, Michael J. , Brophy, Robert H. , Campbell, John , David, Tal S. , Giffin, J. Robert , Johnson, David C., Johnson, Timothy S. , Jones, Morgan H. , Marx, Robert G. , McAllister, David R. , Owens, Brett D. , Shea, Kevin G. , Sherman, Orrin H. , Vidal, Armando F. , Wolf, Brian R.
The American Journal of Sports Medicine | February 3, 2023 | Volume: 51 | Issue: 3 | Pages: 605-614
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; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation ( P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores ( P < .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.