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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2023

08-11-2023 | Obesity | KNEE

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

Authors: David Sproul, Amil Agarwal, Alisa Malyavko, Abhay Mathur, R. Timothy Kreulen, Savyasachi C. Thakkar, Matthew J. Best

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

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Abstract

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.
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Metadata
Title
Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears
Authors
David Sproul
Amil Agarwal
Alisa Malyavko
Abhay Mathur
R. Timothy Kreulen
Savyasachi C. Thakkar
Matthew J. Best
Publication date
08-11-2023
Publisher
Springer Berlin Heidelberg
Keywords
Obesity
Obesity
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07653-z

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