Previous meniscal repair significant predictor of revision ACL reconstruction outcomes
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Patients who have had previous meniscectomy or chondral damage noted at the time of revision ACL reconstruction have worse outcomes at 2 years, but the impact is increased at 6 years, according to recently presented study results.
“Previous medial meniscus repairs or meniscectomies or patellofemoral articular cartilage pathology were found to be the most consistent drivers of outcomes,” Rick W. Wright, MD, professor and chair at the Vanderbilt University Medical Center Department of Orthopaedic Surgery and primary investigator for the Multi-Center ACL Revision Study (MARS), said.
During a presentation of the virtual American Orthopaedic Society for Sports Medicine Annual Meeting, Wright presented the MARS group’s 6-year follow-up results on meniscal and articular cartilage predictors of outcome after revision ACL reconstruction. The MARS Group is currently 83 surgeons at 52 IRB-approved sites, with a 50/50 mix of academic and private-practice orthopedic surgeons.
In the prospective study of 1,234 patients enrolled between 2006 to 2011, 58% of patients were male with a median age of 26 years (range 12 to 63 years). Nine percent of patients in the cohort did not have meniscal or chondral damage; however, 59% had both. Researchers used multivariable analysis to determine if meniscus and chondral pathology predicted outcomes. They obtained a 66% questionnaire follow-up with an additional 11% phone follow-up to document re-ruptures and subsequent surgeries.
“The most significant predictors of worse outcomes were previous, recurrent medial meniscal pathology and grade 3 to 4 patellofemoral chondrosis. Six-year Marx activity levels were negatively impacted by medial meniscus repair or excision and patellar chondrosis. Lateral meniscus repair or excision improved activity scores,” he said.
He said 6-year KOOS were negatively impacted by previous medial meniscectomy, lateral repair and articular cartilage pathology. Lower baseline outcome and activity scores and being a smoker also predicted worse outcomes.
“The study and cohort have many strengths. This demonstrates [the] MARS [group’s] ability to quickly accumulate a large cohort that eclipses in one study the entirety of all previously accumulated patients with 6-year follow-up in the literature. The 50/50 split of private practice and academic surgeons makes the results generalizable to the sports medicine community. The cohort size allows multivariable regression modeling with a high number of variables,” he said.
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Wright RW. Presentation 39. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
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