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. 2021 Dec 16;22(1):54.
doi: 10.1186/s10195-021-00618-3.

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Kathleen Andrä  1   2 , Robert Prill  1 , Enes Kayaalp  3 , Lars Irlenbusch  2 , Eckehard Liesaus  2 , Tilo Trommer  2 , Peter Ullmann  2 , Roland Becker  4
Affiliations

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Kathleen Andrä et al. J Orthop Traumatol. .

Abstract

Purpose: Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R.

Material and methods: Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5-175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views.

Results: Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = -0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R.

Discussion: Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R.

Level of evidence: Level IV-retrospective cohort study.

Keywords: ACL; Anterior cruciate ligament reconstruction; Cartilage degeneration; Failure; Meniscal lesion; Revision; Tunnel placement.

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Conflict of interest statement

There are no competing interests.

Figures

Fig 1
Fig 1
Accumulation of cartilage degeneration for all three compartments at t1 (primary ACL reconstruction) and t2 (revision ACL reconstruction)
See this image and copyright information in PMC

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