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

MARS Group; Rick W Wright¹, Laura J Huston¹, Amanda K Haas², Jacquelyn S Pennings¹, Christina R Allen³, Daniel E Cooper⁴, Thomas M DeBerardino⁵, Warren R Dunn⁶, Brett Brick A Lantz⁷, Kurt P Spindler⁸, Michael J Stuart⁹, John P Albright¹⁰, Annunziato Ned Amendola¹¹, Jack T Andrish⁸, Christopher C Annunziata¹², Robert A Arciero¹³, Bernard R Bach Jr¹⁴, Champ L Baker 3rd¹⁵, Arthur R Bartolozzi¹⁶, Keith M Baumgarten¹⁷, Jeffery R Bechler¹⁸, Jeffrey H Berg¹⁹, Geoffrey A Bernas²⁰, Stephen F Brockmeier²¹, Robert H Brophy², Charles A Bush-Joseph¹⁴, J Brad Butler 5th²², John D Campbell²³, James L Carey²⁴, James E Carpenter²⁵, Brian J Cole¹⁴, Jonathan M Cooper²⁶, Charles L Cox¹, R Alexander Creighton²⁷, Diane L Dahm⁹, Tal S David²⁸, David C Flanigan²⁹, Robert W Frederick³⁰, Theodore J Ganley³¹, Elizabeth A Garofoli², Charles J Gatt Jr¹⁸, Steven R Gecha³², James Robert Giffin³³, Sharon L Hame³⁴, Jo A Hannafin³⁵, Christopher D Harner³⁶, Norman Lindsay Harris Jr³⁷, Keith S Hechtman³⁸, Elliott B Hershman³⁹, Rudolf G Hoellrich⁷, David C Johnson⁴⁰, Timothy S Johnson⁴⁰, Morgan H Jones⁸, Christopher C Kaeding²⁹, Ganesh V Kamath²⁷, Thomas E Klootwyk⁴¹, Bruce A Levy⁴², C Benjamin Ma⁴³, G Peter Maiers 2nd⁴⁴, Robert G Marx³⁵, Matthew J Matava², Gregory M Mathien⁴⁵, David R McAllister³⁴, Eric C McCarty⁴⁶, Robert G McCormack⁴⁷, Bruce S Miller²⁵, Carl W Nissen⁴⁸, Daniel F O'Neill⁴⁹, Brett D Owens⁵⁰, Richard D Parker⁸, Mark L Purnell⁵¹, Arun J Ramappa⁵², Michael A Rauh⁵³, Arthur C Rettig⁴¹, Jon K Sekiya²⁵, Kevin G Shea⁵⁴, Orrin H Sherman⁵⁵, James R Slauterbeck⁵⁶, Matthew V Smith², Jeffrey T Spang²⁷, Ltc Steven J Svoboda⁵⁷, Timothy N Taft²⁷, Joachim J Tenuta⁵⁸, Edwin M Tingstad⁵⁹, Armando F Vidal⁴⁶, Darius G Viskontas⁶⁰, Richard A White⁶¹, James S Williams Jr⁶², Michelle L Wolcott⁴⁶, Brian R Wolf¹⁰, James J York^{63

64}

Affiliations

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.

PMID: 36734487
PMCID: PMC10338044
DOI: 10.1177/03635465231151389

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

MARS Group et al. Am J Sports Med. 2023 Mar.

. 2023 Mar;51(3):605-614.

doi: 10.1177/03635465231151389. Epub 2023 Feb 3.

Authors

Affiliations

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.

PMID: 36734487
PMCID: PMC10338044
DOI: 10.1177/03635465231151389

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.

Keywords: anterior cruciate ligament (ACL); knee articular cartilage; meniscus; outcomes; revision ACL reconstruction.

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Figures

**Figure 1.**
Patient Enrollment Flow Diagram

See this image and copyright information in PMC

References

1. Ahn JH, Lee YS, Ha HC. Comparison of revision surgery with primary anterior cruciate ligament reconstruction and outcome of revision surgery between different graft materials. Am J Sports Med 2008;36(10):1889–1895. - PubMed
1. Anand BS, Feller JA, Richmond AK, Webster KE. Return-to-sport outcomes after revision anterior cruciate ligament reconstruction surgery. Am J Sports Med 2016;44(3):580–584. - PubMed
1. Andriolo L, Filardo G, Kon E, et al. Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2015;23(10):2825–2845. - PubMed
1. Boyle C, Pagoti R, Eng KH, McMahon SE, Nicholas R. Revision ACL reconstruction with autograft: long-term functional outcomes and influencing factors. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie 2019;29(1):157–161. - PubMed
1. Cristiani R, Engstrom B, Edman G, Forssblad M, Stalman A. Revision anterior cruciate ligament reconstruction restores knee laxity but shows inferior functional knee outcome compared with primary reconstruction. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA 2019;27(1):137–145. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical