Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

Author:

,Wright Rick W.1,Huston Laura J.1,Haas Amanda K.2,Pennings Jacquelyn S.1,Allen Christina R.3,Cooper Daniel E.4,DeBerardino Thomas M.5,Dunn Warren R.6,Lantz Brett (Brick) A.7,Spindler Kurt P.8,Stuart Michael J.9,Albright John P.10,Amendola Annunziato (Ned)11,Andrish Jack T.8,Annunziata Christopher C.12,Arciero Robert A.13,Bach Bernard R.14,Baker Champ L.15,Bartolozzi Arthur R.16,Baumgarten Keith M.17,Bechler Jeffery R.18,Berg Jeffrey H.19,Bernas Geoffrey A.20,Brockmeier Stephen F.21,Brophy Robert H.2,Bush-Joseph Charles A.14,Butler J. Brad22,Campbell John D.23,Carey James L.24,Carpenter James E.25,Cole Brian J.14,Cooper Jonathan M.26,Cox Charles L.1,Creighton R. Alexander27,Dahm Diane L.9,David Tal S.28,Flanigan David C.29,Frederick Robert W.30,Ganley Theodore J.31,Garofoli Elizabeth A.2,Gatt Charles J.18,Gecha Steven R.32,Giffin James Robert33,Hame Sharon L.34,Hannafin Jo A.35,Harner Christopher D.36,Harris Norman Lindsay37,Hechtman Keith S.38,Hershman Elliott B.39,Hoellrich Rudolf G.7,Johnson David C.40,Johnson Timothy S.40,Jones Morgan H.8,Kaeding Christopher C.29,Kamath Ganesh V.27,Klootwyk Thomas E.41,Levy Bruce A.42,Ma C. Benjamin43,Maiers G. Peter44,Marx Robert G.35,Matava Matthew J.2,Mathien Gregory M.45,McAllister David R.34,McCarty Eric C.46,McCormack Robert G.47,Miller Bruce S.25,Nissen Carl W.48,O’Neill Daniel F.49,Owens Brett D.50,Parker Richard D.8,Purnell Mark L.51,Ramappa Arun J.52,Rauh Michael A.53,Rettig Arthur C.41,Sekiya Jon K.25,Shea Kevin G.54,Sherman Orrin H.55,Slauterbeck James R.56,Smith Matthew V.2,Spang Jeffrey T.27,Svoboda LTC Steven J.57,Taft Timothy N.27,Tenuta Joachim J.58,Tingstad Edwin M.59,Vidal Armando F.46,Viskontas Darius G.60,White Richard A.61,Williams James S.62,Wolcott Michelle L.46,Wolf Brian R.10,York James J.6364

Affiliation:

1. Vanderbilt University, Nashville, Tennessee, USA

2. Washington University in St Louis, St Louis, Missouri, USA

3. Yale University, New Haven, Connecticut, USA

4. WB Carrell Memorial Clinic, Dallas, Texas, USA

5. The San Antonio Orthopaedic Group, San Antonio, Texas, USA

6. Texas Orthopedic Hospital, Houston, Texas, USA

7. Slocum Research and Education Foundation, Eugene, Oregon, USA

8. Cleveland Clinic, Cleveland, Ohio, USA

9. Mayo Clinic, Rochester, Minnesota, USA

10. University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA

11. Duke University, Durham, North Carolina, USA

12. Commonwealth Orthopaedics and Rehabilitation, Arlington, Virginia, USA

13. University of Connecticut Health Center, Farmington, Connecticut, USA

14. Rush University Medical Center, Chicago, Illinois, USA

15. The Hughston Clinic, Columbus, Georgia, USA

16. 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA

17. Orthopedic Institute, Sioux Falls, South Dakota, USA

18. University Orthopaedic Associates LLC, Princeton, New Jersey, USA

19. Town Center Orthopaedic Associates, Reston, Virginia, USA

20. State University of New York at Buffalo, Buffalo, NY

21. University of Virginia, Charlottesville, Virginia, USA

22. Orthopedic and Fracture Clinic, Portland, Oregon, USA

23. Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA

24. University of Pennsylvania, Philadelphia, Pennsylvania, USA

25. University of Michigan, Ann Arbor, Michigan, USA

26. HealthPartners Specialty Center, St Paul, Minnesota, USA

27. University of North Carolina Medical Center, Chapel Hill, North Carolina, USA

28. Synergy Specialists Medical Group, San Diego, California, USA

29. The Ohio State University, Columbus, Ohio, USA

30. The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA

31. Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

32. Princeton Orthopaedic Associates, Princeton, New Jersey, USA

33. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada

34. David Geffen School of Medicine at UCLA, Los Angeles, California, USA

35. Hospital for Special Surgery, New York, New York, USA

36. University of Texas Health Center, Houston, Texas, USA

37. Grand River Health, Rifle, Colorado, USA

38. UHZ Sports Medicine Institute, Coral Gables, Florida, USA

39. Lenox Hill Hospital, New York, New York, USA

40. National Sports Medicine Institute, Leesburg, Virginia, USA

41. Methodist Sports Medicine, Indianapolis, Indiana, USA

42. Mayo Clinic Rochester, Minnesota, USA

43. University of California, San Francisco, California, USA

44. Methodist Sports Medicine Center, Indianapolis, Indiana, USA

45. Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA

46. University of Colorado Denver School of Medicine, Denver, Colorado, USA

47. University of British Columbia/Fraser Health Authority, British Columbia, Canada

48. Connecticut Children’s Medical Center, Hartford, Connecticut, USA

49. Littleton Regional Healthcare, Littleton, New Hampshire, USA

50. Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA

51. Aspen Orthopedic Associates, Aspen, Colorado, USA

52. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

53. State University of New York at Buffalo, Buffalo, New York, USA

54. Intermountain Orthopaedics, Boise, Idaho, USA

55. NYU Hospital for Joint Diseases, New York, New York, USA

56. University of South Alabama, Mobile, Alabama, USA

57. Keller Army Community Hospital, United States Military Academy, West Point, New York, USA

58. Albany Medical Center, Albany, New York, USA

59. Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA

60. Royal Columbian Hospital, New Westminster, British Columbia, Canada

61. Fitzgibbon’s Hospital, Marshall, Missouri, USA

62. Cleveland Clinic, Euclid, Ohio, USA

63. Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA

64. Investigation performed at Vanderbilt University, Nashville, Tennessee, USA

Abstract

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.

Funder

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Publisher

SAGE Publications

Subject

Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine

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