학술논문
Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study.
Document Type
article
Author
Wright, Rick; Huston, Laura; Haas, Amanda; Pennings, Jacquelyn; Allen, Christina; Cooper, Daniel; DeBerardino, Thomas; Dunn, Warren; Lantz, Brett; Spindler, Kurt; Stuart, Michael; Albright, John; Amendola, Annunziato; Andrish, Jack; Annunziata, Christopher; Arciero, Robert; Bach, Bernard; Baker, Champ; Bartolozzi, Arthur; Baumgarten, Keith; Bechler, Jeffery; Berg, Jeffrey; Bernas, Geoffrey; Brockmeier, Stephen; Brophy, Robert; Bush-Joseph, Charles; Butler, J; Campbell, John; Carey, James; Carpenter, James; Cole, Brian; Cooper, Jonathan; Cox, Charles; Creighton, R; Dahm, Diane; David, Tal; Flanigan, David; Frederick, Robert; Ganley, Theodore; Garofoli, Elizabeth; Gatt, Charles; Gecha, Steven; Giffin, James; Hame, Sharon; Hannafin, Jo; Harner, Christopher; Harris, Norman; Hechtman, Keith; Hershman, Elliott; Hoellrich, Rudolf; Johnson, David; Johnson, Timothy; Jones, Morgan; Kaeding, Christopher; Kamath, Ganesh; Klootwyk, Thomas; Levy, Bruce; Maiers, G; Marx, Robert; Matava, Matthew; Mathien, Gregory; McAllister, David; McCarty, Eric; McCormack, Robert; Miller, Bruce; Nissen, Carl; ONeill, Daniel; Owens, Brett; Parker, Richard; Purnell, Mark; Ramappa, Arun; Rauh, Michael; Rettig, Arthur; Sekiya, Jon; Shea, Kevin; Sherman, Orrin; Slauterbeck, James; Smith, Matthew; Spang, Jeffrey; Svoboda, Ltc; Taft, Timothy; Tenuta, Joachim; Tingstad, Edwin; Vidal, Armando; Viskontas, Darius; White, Richard; Williams, James; Wolcott, Michelle; Wolf, Brian; York, James; Ma, C Benjamin
Source
The American Journal of Sports Medicine. 51(3)
Subject
Language
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 patients 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.