Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears.

Autor: Sproul D; The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA. dsproul@gwu.edu., Agarwal A; The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA., Malyavko A; The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA., Mathur A; The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA., Kreulen RT; Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA., Thakkar SC; Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA., Best MJ; Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2023 Dec; Vol. 31 (12), pp. 5823-5829. Date of Electronic Publication: 2023 Nov 08.
DOI: 10.1007/s00167-023-07653-z
Abstrakt: Purpose: A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence.
Methods: A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear.
Results: There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5-4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0-3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1-1.4), male gender (OR: 1.1; CI 1.1-1.2; p < 0.001), obesity (OR: 1.1; CI 1.1-1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1-1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0-1.0; p < 0.001).
Conclusions: This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears.
Level of Evidence: Level III, prognostic trial.
(© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
Databáze: MEDLINE
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