From Reuters Health Information

Meniscal Damage Tied to Knee Arthritis After ACL Repair

NEW YORK (Reuters Health) Jul 06 - Meniscal injury is a key factor in the progression of chondral injury among patients undergoing anterior cruciate ligament (ACL) reconstruction, according to a June 6th online report in the American Journal of Sports Medicine.

In fact, the authors suggest that meniscal damage could be more important in the progression of chondral damage and osteoarthritis than the ACL injury itself.

Dr. James R. Borchers of The Ohio State University in Columbus and his colleagues write that patients who undergo ACL reconstruction typically have damage to the meniscal and articular cartilage, but there's little information on how this damage may differ between patients undergoing primary ACL reconstruction and those having revision surgery.

To investigate, they studied data from the Multicenter Orthopedic Outcomes Network (MOON) and the Multicenter ACL Revision Study (MARS) on 508 patients who received primary ACL reconstruction and 281 patients who had revision surgery.

The likelihood of new, untreated medial meniscal tears was the same in both groups, although new untreated lateral meniscal tears were 46% less common in patients undergoing revision surgery.

Severe cartilage damage in the lateral compartment and the patellar-trochlear compartment (Outerbridge grade 3 and 4) was more common with revision surgery, with odds ratios of 1.73 and 1.70, respectively, compared to primary surgery. However, the likelihood of damage in the medial compartment was the same in both groups.

Having had a prior medial meniscectomy on the medial femoral condyle increased the risk of articular cartilage injury in both the primary and revision groups 1.44-fold, while prior meniscectomy on the medial tibial plateau increased articular injury risk 1.63-fold.

Prior lateral meniscectomy also increased risk of severe articular cartilage damage in both groups, 1.65-fold for the lateral femoral condyle and 1.56-fold for the lateral tibial plateau.

When the researchers controlled for meniscal status, they found an increased risk of chondral injury to the lateral and patellofemoral compartments in the patients undergoing revision surgery compared to those having primary surgery. This finding suggests, they say, that chondral damage likely progresses after failed primary ACL reconstruction.

"While our current study cannot identify all risks after primary reconstruction for the progression of chondral damage, it suggests the need to closely examine the early time period after primary ACL reconstruction and the prevention of further chondral damage," Dr. Borchers and his colleagues write.

For further information: http://www.medscape.com/viewarticle/745931?src=mp&spon=8