Medial meniscus pathology most common cause of surgery after ACL reconstruction
Click Here to Manage Email Alerts
Medial meniscus pathology and ACL tears were among the most common reasons patients needed surgery after ACL reconstruction, according to presented study results.
“When surgeons are talking to a patient about ACL surgery, they need to let them know there is a 20% chance they are going to have a subsequent surgery within 6 years and it is most likely going to be related to their ACL having a retear or a medial meniscus pathology,” Jaron P. Sullivan, MD, assistant professor at Vanderbilt Orthopedics, told Orthopedics Today.
To identify the common pathologies and risk factors related to subsequent surgery after ACL reconstruction, Sullivan and his colleagues analyzed operative reports at 2- and 6-year follow-up of 3,276 patients who underwent ACL reconstruction. Researchers constructed logistical regression models to predict which patient demographic and surgical variables were associated with the incidence of having a subsequent surgery following index ACL reconstruction.
Risk for subsequent surgery
According to Sullivan, who presented the findings at the American Orthopaedic Society for Sports Medicine Annual Meeting, 20% of patients underwent a subsequent procedure within 6 years of ACL reconstruction.
“Revision ACL reconstruction was the most common procedure performed at 7.5%,” Sullivan said in his presentation. “Meniscus surgeries, grouped together, made up the majority of subsequent surgeries at 11.9%. There were about twice as many medial meniscus surgeries compared to lateral.”
Sullivan said 6.7% of patients underwent subsequent articular cartilage procedures, of which chondroplasty made up about 50%, and 7.8% of patients underwent loss of motion procedures with anterior debridement being most common.
Medial meniscus repair or an untreated tear, hamstring graft, higher baseline Marx activity level, lower age, previous ACL reconstruction, articular cartilage pathology or patients who quit smoking vs. non-smokers were predictors of subsequent meniscal surgery at 6 years, Sullivan said.
“If patients had a medial meniscus repair, they were 4.4 times more likely to have a subsequent meniscus surgery compared to no meniscus problems,” he said. “Medial meniscus tears that were left untreated were 1.9 times more like to have a subsequent surgery.”
Sullivan said hamstring autograft or allograft, grade 3 or 4 articular cartilage pathology in any compartment, higher BMI, higher baseline Marx activity level or meniscus repair were predictors of subsequent articular cartilage surgeries at 6 years.
“The following are predictors of subsequent surgeries for loss of motion at 6 years: females are 2.5 times more likely to have loss of motion, lower baseline KOOS symptom scores, younger patients,” Sullivan said.
Improve treatment, techniques
Sullivan told Orthopedics Today it is important to improve surgical techniques when reoperation needs to be continuously performed on the medial meniscus regardless of treatment, as well as to identify what about the medial meniscus is the cause of any subsequent procedures.
He added, understanding the types of tears and how they correlate with the meniscus may help physicians identify the best treatment options.
“Understanding the specifics about the pathology would be helpful because if surgeons see a tear and they think, ‘It is more likely to have a subsequent surgery if I fix it, maybe I should just trim it out’, but it does not tell what type of tear or the patterns,” Sullivan said. “So, understanding the specific types of injuries, subcategories of injuries and how those correlate would be helpful.”
- Reference:
- Sullivan JP, et al. Paper 22. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
- For more information:
- Jaron P. Sullivan, MD, can be reached at 1215 21st Ave. S., Suite 4200, Nashville, TN 37232; email: tommy.e.wilemon@vumc.org.
Perspective
Back to Top
Collapse
Read more about
Click Here to Manage Email Alerts