Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes After Anterior Cruciate Ligament Reconstruction?

Abstract

Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse, but conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and ACL revisions. Conclusions Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years following ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years.

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

“…Early symptoms predict postsurgical outcomes years after an ACL reconstruction. [24][25][26] Future longitudinal studies that assess whether baseline traumatic BML size can predict patient-reported outcomes years after surgery or that evaluate whether changes in traumatic BML size relate to changes in knee pain will help build on these findings. Second, it remains unclear if the associations presented here were confounded by inflammation or concurrent injuries (eg, meniscal injury or chondral lesions) that could have contributed to the development of both traumatic BML volumes and knee pain.…”

“…24 Furthermore, preoperative knee and body pain are important predictors of postsurgical outcomes 1 or 2 years after an ACL reconstruction. 25,26 Thus, enhancing our understanding of the factors involved in posttraumatic pain may be important in improving long-term results for the ACL-injured population.…”

Knee-Extension Torque Variability and Subjective Knee Function in Patients With a History of Anterior Cruciate Ligament Reconstruction

“…Pietrosimone et al 4 observed larger correlations (r ¼ 0.78) and stronger predictability (R 2 ¼ 0.61) between strength and IKDC scores in patients who had undergone ACL-R. Their ACL-R cohort reported levels of disability (IKDC score ¼ 86.1 6 8.9) and postoperative time (4.5 6 3.4 years) similar to those in our study; yet their peak torque values (2.73 6 0.57 Nm) were higher and their sample size (n ¼ 15) was smaller. 4 Multiple variables may contribute to subjective knee function after ACL-R, including psychological factors, 31 surgical technique, 32 associated knee damage, 33 activity demands, 34 and overall health of the patient. 35 The results of our predictive model indicated that as months after surgery increased (ranging from 6 to 107 months [8.9 years]), subjective knee function increased.…”

Evaluation of Peripheral Vertical Nondegenerative Medial Meniscus Tears Treated With Trephination Alone at the Time of Anterior Cruciate Ligament Reconstruction

“…Other studies that evaluate long-term subjective results have found that partial meniscectomy is associated with lower scores than seen in patients with intact menisci. 8,28 The mean time of subsequent MMT in our study group was 3.6 years after ACL reconstruction. Shelbourne and Gray 8 showed that patients who underwent meniscectomy did not begin to have a decline in subjective scores until around 10 years after surgery.…”