Robert H Brophy1,2, Laura J Huston3,2, Isaac Briskin4,2, Annunziato Amendola5,2, Charles L Cox6,2, Warren R Dunn7,2, David C Flanigan8,2, Morgan H Jones9,2, Christopher C Kaeding8,2, Robert G Marx10,2, Matthew J Matava11,2, Eric C McCarty12,2, Richard D Parker9,2, Armando F Vidal2, Michelle L Wolcott12,2, Brian R Wolf13,2, Rick W Wright14,2, Kurt P Spindler15,2. 1. Department of Orthopaedic Surgery, Washington University School of Medicine, Chesterfield, Missouri, USA. 2. Investigation performed at Washington University, Chesterfield, Missouri, USA, Vanderbilt, Nashville, Tennessee, USA, and Cleveland Clinic, Garfield Heights, Ohio, USA. 3. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 4. Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA. 5. Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA. 6. Vanderbilt University, Nashville, Tennessee, USA. 7. Fondren Orthopedic Research Institute, Houston, Texas, USA. 8. Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA. 9. Department of Orthopaedics, Cleveland Clinic Foundation, Garfield Heights, Ohio, USA. 10. Department of Orthopaedics, Hospital for Special Surgery, New York, New York, USA. 11. Department of Orthopaedics, Washington University School of Medicine, Chesterfield, Missouri, USA. 12. CU Sports Medicine, Boulder, Colorado, USA. 13. Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA. 14. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 15. Department of Orthopaedics, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. HYPOTHESIS/ PURPOSE: The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 1. METHODS: Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. RESULTS: A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral (P < .01) and medial (P < .05) compartments and previous medial meniscal surgery (7% of knees; P < .04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. CONCLUSION: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes.
BACKGROUND: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. HYPOTHESIS/ PURPOSE: The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 1. METHODS: Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. RESULTS: A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral (P < .01) and medial (P < .05) compartments and previous medial meniscal surgery (7% of knees; P < .04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. CONCLUSION: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes.
Authors: Jaron P Sullivan; Laura J Huston; Alexander Zajichek; Emily K Reinke; Jack T Andrish; Robert H Brophy; Warren R Dunn; David C Flanigan; Christopher C Kaeding; Robert G Marx; Matthew J Matava; Eric C McCarty; Richard D Parker; Armando F Vidal; Brian R Wolf; Rick W Wright; Kurt P Spindler Journal: Am J Sports Med Date: 2020-08 Impact factor: 6.202
Authors: Eric Hamrin Senorski; Eleonor Svantesson; Kurt P Spindler; Eduard Alentorn-Geli; David Sundemo; Olaf Westin; Jon Karlsson; Kristian Samuelsson Journal: Am J Sports Med Date: 2018-08-13 Impact factor: 6.202
Authors: Hana Marmura; Andrew Firth; Lachlan Batty; Dianne M Bryant; Alan M J Getgood Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-04-22 Impact factor: 4.114