Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study
Authors:   The MARS Group, Wright Rick W. , Huston Laura J. , Haas Amanda K. , Pennings Jacquelyn S. , Allen Christina R. , Cooper Daniel E. , DeBerardino Thomas M. , Dunn Warren R. , Lantz Brett (Brick) A. , Spindler Kurt P. , Stuart Michael J. , Albright John P. , Amendola Annunziato (Ned) , 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. , Brophy Robert H. , Bush-Joseph Charles A. , Butler J. Brad , Campbell John D. , Carey James L. , Carpenter James E. , Cole Brian J. , Cooper Jonathan M. , Cox Charles L. , Creighton R. Alexander , Dahm Diane L. , David Tal S. , Flanigan David C. , Frederick Robert W. , Ganley Theodore J. , Garofoli Elizabeth A. , Gatt Charles J. , Gecha Steven R. , Giffin James Robert , Hame Sharon L. , Hannafin Jo A. , Harner Christopher D. , Harris Norman Lindsay , Hechtman Keith S. , Hershman Elliott B. , Hoellrich Rudolf G. , Johnson David C. , Johnson Timothy S. , Jones Morgan H. , Kaeding Christopher C. , Kamath Ganesh V. , Klootwyk Thomas E. , Levy Bruce A. , Ma C. Benjamin , Maiers G. Peter , Marx Robert G. , Matava Matthew J. , Mathien Gregory M. , McAllister David R. , McCarty Eric C. , McCormack Robert G. , Miller Bruce S. , Nissen Carl W. , O’Neill Daniel F. , Owens Brett D. , Parker Richard D. , Purnell Mark L. , Ramappa Arun J. , Rauh Michael A. , Rettig Arthur C. , Sekiya Jon K. , Shea Kevin G. , Sherman Orrin H. , 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. , Wolf Brian R. , York James J. 
Published: February 2023

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.