Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0T MR imaging

Michalitsis, Sotirios; Hantes, Michael; Thriskos, Paschalis; Tsezou, Aspasia; Malizos, Konstantinos N.; Fezoulidis, Ioannis; Vlychou, Marianna

doi:10.1007/s00167-016-4153-7

Cited by 15 publications

(12 citation statements)

References 42 publications

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“…1 A previous study of 29 patients with follow-up MRI at 2 years demonstrated similar findings of tricompartmental cartilage loss after ACLR, with an increased risk of cartilage loss after medial meniscal surgery, although that study was too small to clearly delineate the findings of lateral meniscectomy. 14 The primary outcome was the cartilage damage score (CDS), with each subregional score determined by computing the score for the ipsilateral knee minus the score for the contralateral knee and summed for the compartment or whole joint. A positive value for the CDS indicates that the reconstructed knee has more cartilage damage than the contralateral healthy knee.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…6,8,17,18,20 Studies evaluating short-term outcomes, however, are more limited in scope. 3,14,16 We have previously used a novel nested cohort of young active patients who returned on-site within the larger prospective Multicenter Orthopaedic Outcomes Network (MOON) cohort to demonstrate predictors of radiographic PTOA at 2 to 3 years after ACLR in the medial and lateral compartments. [6][7][8] Medial meniscal repair, partial meniscectomy, and older age predicted a narrower joint space in the medial compartment at 2 to 3 years postoperatively.…”

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confidence: 99%

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Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort

Altahawi,

Reinke,

Briskin

et al. 2022

Am J Sports Med

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Background: Patients undergoing anterior cruciate ligament reconstruction (ACLR) are at an increased risk for posttraumatic osteoarthritis (PTOA). While we have previously shown that meniscal treatment with ACLR predicts more radiographic PTOA at 2 to 3 years postoperatively, there are a limited number of similar studies that have assessed cartilage directly with magnetic resonance imaging (MRI). Hypothesis: Meniscal repair or partial meniscectomy at the time of ACLR independently predicts more articular cartilage damage on 2- to 3-year postoperative MRI compared with a healthy meniscus or a stable untreated tear. Study Design: Cohort study; Level of evidence, 2. Methods: A consecutive series of patients undergoing ACLR from 1 site within the prospective, nested Multicenter Orthopaedic Outcomes Network (MOON) cohort underwent bilateral knee MRI at 2 to 3 years postoperatively. Patients were aged <36 years without previous knee injuries, were injured while playing sports, and had no history of concomitant ligament surgery or contralateral knee surgery. MRI scans were graded by a board-certified musculoskeletal radiologist using the modified MRI Osteoarthritis Knee Score (MOAKS). A proportional odds logistic regression model was built to predict a MOAKS-based cartilage damage score (CDS) relative to the contralateral control knee for each compartment as well as for the whole knee, pooled by meniscal treatment, while controlling for sex, age, body mass index, baseline Marx activity score, and baseline operative cartilage grade. For analysis, meniscal injuries surgically treated with partial meniscectomy or meniscal repair were grouped together. Results: The cohort included 60 patients (32 female; median age, 18.7 years). Concomitant meniscal treatment at the time of index ACLR was performed in 17 medial menisci (13 meniscal repair and 4 partial meniscectomy) and 27 lateral menisci (3 meniscal repair and 24 partial meniscectomy). Articular cartilage damage was worse in the ipsilateral reconstructed knee ( P < .001). A meniscal injury requiring surgical treatment with ACLR predicted a worse CDS for medial meniscal treatment (medial compartment CDS: P = .005; whole joint CDS: P < .001) and lateral meniscal treatment (lateral compartment CDS: P = .038; whole joint CDS: P = .863). Other predictors of a worse relative CDS included age for the medial compartment ( P < .001), surgically observed articular cartilage damage for the patellofemoral compartment ( P = .048), and body mass index ( P = .007) and age ( P = .020) for the whole joint. Conclusion: A meniscal injury requiring surgical treatment with partial meniscectomy or meniscal repair at the time of ACLR predicted worse articular cartilage damage on MRI at 2 to 3 years after surgery. Further research is required to differentiate between the effects of partial meniscectomy and meniscal repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort

Altahawi,

Reinke,

Briskin

et al. 2022

Am J Sports Med

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“…Cartilage degeneration at different sites of the knee occurs after anterior cruciate ligament reconstruction (ACL-R) [ 9 , 14 , 23 ]. Older age, higher body mass index (BMI), meniscal tears, and technical errors may accelerate cartilage degeneration after primary ACL-R [ 11 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

et al. 2021

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Purpose Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R. Material and methods Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5–175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views. Results Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = −0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R. Discussion Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R. Level of evidence: Level IV—retrospective cohort study.

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“…Accompanying meniscal injury has been the most commonly reported risk factor for OA development following ACLR [1]. Evaluating articular cartilage changes after a 2-year follow-up in patients who underwent arthroscopic ACLR with or without concomitant meniscal surgery, Michalitsis et al reported more chondral defects in the group that underwent partial meniscectomy at the time of arthroscopic ACLR [10].…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Femoral Cartilage Thickness After Anterior Cruciate Ligament Reconstruction

Üşen

Tolu

2020

IJOO

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Background This study aimed to evaluate the changes in the distal femoral cartilage thickness in patients that underwent anterior cruciate ligament reconstruction (ACLR) and to analyze their association with concomitant meniscal surgery, knee muscle strength, kinesophobia, and physical activity level. Methods The demographic characteristics and surgical data of 47 male patients that underwent unilateral ACLR (mean, 27.55 ± 5.63; range, 18-40 years) were evaluated. The patients were assessed in three groups depending on surgery: isolated ACLR (n = 15), ACLR + partial medial meniscus resection (ACLR&M) (n = 16), and ACLR + medial meniscus repair (ACLR&MR) (n = 16). The medial (MCCT), intercondylar (ICCT), and lateral (LCCT) femoral cartilage thicknesses on both limbs were measured using ultrasonography. The extensor and flexor muscles strength of the knees was assessed using an isokinetic dynamometer at 60°/s. The physical activity level was evaluated by the International Physical Activity Questionnaire (IPAQ) short form and Tegner Activity Scale (TAS). The fear of movement was assessed by the Tampa Scale for Kinesiophobia Questionnaire (TSKQ). ResultsThe postoperative mean follow-up duration was 32.24 ± 9.17 months. MCCT and LCCT were significantly decreased in the ACLR&M group (p < 0.001 and p = 0.019, respectively). MCCT, ICCT and LCCT were significantly decreased in the ACLR&MR group (p = 0.017, p = 0.011, and p = 0.004, respectively). No significant change was found in the ACLR group. Cartilage thickness changes were not significantly correlated with the knee muscle strength, IPAQ, TAS and TSKQ scores in all groups (p > 0.05). ConclusionThe results showed partial meniscectomy and meniscus repair at the time of ACLR as important risk factors for decreased chondral thickness.

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Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0T MR imaging

Abstract: Prospective comparative study, Level II.

Cited by 15 publications

References 42 publications

Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort

Meniscal Treatment as a Predictor of Worse Articular Cartilage Damage on MRI at 2 Years After ACL Reconstruction: The MOON Nested Cohort

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Factors Affecting the Femoral Cartilage Thickness After Anterior Cruciate Ligament Reconstruction

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