LAS VEGAS — A retrospective study of 3,425 patients who underwent primary ACL reconstruction and had no meniscal pathology at the time of surgery and a normal contralateral knee showed a significantly higher odds of patients later having meniscal surgery on their reconstructed knee compared with their contralateral joint.
Investigators also found primary ACL reconstructions performed with allograft and hamstring autograft were associated with a higher rate of subsequent meniscus surgery compared to procedures performed with bone-patella tendon-bone autograft (BPTB), with hazard ratios of 5.07 and 3.66 for allograft and hamstring autograft, respectively.
“ACL reconstruction had less of a meniscal-protective effect than the contralateral native ACL,” Brent R. Davis, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting. “While studies show ACL reconstruction has a meniscal-protective effect compared to nonoperative treatment, the current study would suggest that the knee is not restored to normal after reconstruction. The higher risk of subsequent meniscal surgery with allografts and hamstring autografts should be considered when determining the appropriate graft choice, and meniscal tear after ACL reconstruction is an outcome variable that should be considered when validating the success of this surgery or when comparing various ACL reconstruction techniques.”
Davis and colleagues used the Kaiser Permanente ACL Reconstruction Registry to identify the study group, of which 56.6% were men and the average age was 26.2 years. The graft types used for primary ACL reconstruction included allograft (40%), hamstring autograft (33%) and BPTB autograft (26.5%).
Researchers discovered 47 subsequent meniscal surgeries in the ACL reconstructed knee (1.37%) and 13 meniscal surgeries in the contralateral knee (0.38%).
“This represented a 3.7-times higher risk of subsequent meniscal surgery on the operative knee compared to the contralateral knee,” Davis said. – by Gina Brockenbrough, MA
Davis BR, et al. Paper #245. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.
Disclosure: Davis reports no relevant financial disclosures.