Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction

Abstract

Background Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared to primary ACL reconstructions. The purpose of this study was to determine if the prevalence, location and/or degree of meniscal and chondral damage noted at the time of revision ACL reconstruction predicts activity level, sports function, and osteoarthritis symptoms at two-year follow-up. Hypothesis The hypothesis is that meniscal loss and high grade chondral damage noted at the time of revision ACL reconstruction will result in lower activity levels, decreased sports participation, more pain, more stiffness and more functional limitation at two years following revision surgery. Study Design Cohort Study; Level of evidence, 2. Methods Between 2006 and 2011, 1205 patients who underwent revision ACL reconstruction by 83 surgeons at 52 hospitals were accumulated for study of the relationship of meniscal pathology and articular cartilage pathology to outcome. Baseline demographic and intraoperative data, including the IKDC subjective knee evaluation, KOOS, WOMAC and Marx activity score were collected initially and at two years follow-up to test the hypothesis. Regression analysis was used to control for age, gender, body mass index, smoking status, activity level, baseline outcome scores, revision number, time since last ACL reconstruction, incidence of having a previous ACL reconstruction on the contralateral knee, previous and current meniscal and articular cartilage pathology, graft choice, and surgeon years of experience, in order to assess the meniscal and articular cartilage pathology risk factors for clinical outcomes two years after revision ACL reconstruction. Results At two years follow-up 82% (989/1205) of the patients returned their questionnaires. It was found that previous meniscal pathology and current articular cartilage pathology were associated with the poorest outcomes, with prior lateral meniscectomy and current grade III–IV trochlear articular cartilage changes having the worst outcome scores. Activity levels at two years were not affected by meniscal or articular cartilage pathology. Conclusions Prior lateral meniscectomy and current grade III–IV changes of the trochlea are associated with worse outcomes in terms of decreased sports participation, more pain, more stiffness and more functional limitation at two years following revision surgery, but had no effect on activity levels. Clinical Relevance This study emphasizes the importance of the lateral meniscus, particularly in the presence of an ACL injury. Preservation of this structure should be one of the highest priorities during reconstructive surgery. Grade III–IV changes in the trochlea also has severe detrimental effects on the outcome of revision ACL reconstruction and measures need to be employed to prevent conditions that bring out deterioration of the trochlear cartilage.

Patient-Reported Outcomes After Multiple-Revision ACL Reconstruction: Good but Not Great

“…High rates of chondral pathology and meniscal tears with multiple revision ACL reconstruction have also been shown by Wegrzyn et al., who noted 11 medial and lateral meniscal tears in their series of 10 patients undergoing second revision ACL reconstruction surgery. 42 Meniscal pathology has been shown to increase the risk of poor outcomes 43 , 44 and graft rupture in the setting of revision ACL reconstruction. 30 Cartilage pathology has also been shown to worsen outcomes in this setting, with increased pain, stiffness and functional limitation.…”

“… 30 Cartilage pathology has also been shown to worsen outcomes in this setting, with increased pain, stiffness and functional limitation. 43 , 44 …”

Predictors of Hip Pain and Function in Femoroacetabular Impingement: A Prospective Cohort Analysis

“…The baseline measurement of joint pain and function at the time of surgery is a predictor of the final outcome. 6 , 24 It is important to understand which patient factors (including mental health) and arthroscopic characteristics of FAI contribute to hip pain and function. While similar studies have been performed on the shoulder, 25 knee, 3 , 6 , 10 and spine, 9 no comprehensive study inclusive of patient factors and intra-articular findings has been performed on baseline predictors of hip pain and function among patients with FAI.…”

Outcome After Anterior Cruciate Ligament Revision

“…Interestingly, several studies have reported that lower prevalence of meniscal injuries at ACL revision is mainly a result of a decrease in lateral meniscal injuries, while the prevalence of medial meniscal injuries is similar between primary and revision ACL reconstruction [46, 49]. Thus, medial meniscus injuries are more common than lateral meniscus injuries in ACL revision [42, 44, 50, 51].…”