Risk Factors and Predictors of Significant Chondral Surface Change from Primary to Revision ACL Reconstruction: A MOON and MARS Cohort Study

Autor: Magnussen, Robert A., Borchers, James R., Pedroza, Angela D., Huston, Laura J., Haas, Amanda K., Spindler, Kurt P., Wright, Rick W., Kaeding, Christopher C., Allen, Christina R., Anderson, Allen F., Cooper, Daniel E., DeBerardino, Thomas M., Dunn, Warren R., Lantz, Brett A., Mann, Barton, Stuart, Michael J., Albright, John P., Amendola, Annunziato, Andrish, Jack T., Annunziata, Christopher C., Arciero, Robert A., Bach, Bernard R., Baker, Champ L., Bartolozzi, Arthur R., Baumgarten, Keith M., Bechler, Jeffery R., Berg, Jeffrey H., Bernas, Geoffrey A., Brockmeier, Stephen F., Brophy, Robert H., Bush-Joseph, Charles A., Butler, J. Brad, Campbell, John D., Carey, James L., Carpenter, James E., Cole, Brian J., Cooper, Jonathan M., Cox, Charles L., Creighton, R. Alexander, Dahm, Diane L., David, Tal S., Flanigan, David C., Frederick, Robert W., Ganley, Theodore J., Garofoli, Elizabeth A., Gatt, Charles J., Gecha, Steven R., Giffin, James Robert, Hame, Sharon L., Hannafin, Jo A., Harner, Christopher D., Harris, Norman Lindsay, Hechtman, Keith S., Hershman, Elliott B., Hoellrich, Rudolf G., Hosea, Timothy M., Johnson, David C., Johnson, Timothy S., Jones, Morgan H., Kamath, Ganesh V., Klootwyk, Thomas E., Levy, Bruce A., Ma, C. Benjamin, Maiers, G. Peter, Marx, Robert G., Matava, Matthew J., Mathien, Gregory M., McAllister, David R., McCarty, Eric C., McCormack, Robert G., Miller, Bruce S., Nissen, Carl W., O’Neill, Daniel F., Owens, Brett D., Parker, Richard D., Purnell, Mark L., Ramappa, Arun J., Rauh, Michael A., Rettig, Arthur C., Sekiya, Jon K., Shea, Kevin G., Sherman, Orrin H., Slauterbeck, James R., Smith, Matthew V., Spang, Jeffrey T., Svoboda, Steven J., Taft, Timothy N., Tenuta, Joachim J., Tingstad, Edwin M., Vidal, Armando F., Viskontas, Darius G., White, Richard A., Williams, James S., Wolcott, Michelle L., Wolf, Brian R., York, James J.
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Popis: BACKGROUND: Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. HYPOTHESIS: We hypothesized that larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. STUDY DESIGN: Prospective cohort study METHODS: Subjects who had both primary and revision data contained in the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) databases were included. Data reviewed included chondral surface status at the time of primary and revision surgery, meniscal status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartments according to progression on the modified Outerbridge scale (increase of ≥1 grade) or a greater than 25% enlargement in any area of damage. Logistic regression was used to identify predictors of significant chondral surface change in each compartment from primary to revision surgery. RESULTS: A total of 134 patients were included with a median age19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 patients (23.9%) in the medial compartment, and 31 patients (23.1%) in the patellofemoral compartment. In the lateral compartment, patients who had greater than 33% of their lateral meniscus excised at primary reconstruction had 16.9 times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus (p < 0.001). In the medial compartment, patients who had less than 33% of their medial meniscus excised at the time of the primary reconstruction had 4.8 times greater odds of progression of articular cartilage injury than those with an intact medial meniscus (p = 0.02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age (p ≤0.02). In the patellofemoral compartment, the use of allograft was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft (p < 0.001). Each one unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage (p = 0.046) in the patellofemoral compartment. CONCLUSION: Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
Databáze: OpenAIRE
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