Abstract
PurposeDegeneration 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 methodsIsolated 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.ResultsCartilage 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.DiscussionAccelerated 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.
Highlights
Cartilage degeneration at different sites of the knee occurs after anterior cruciate ligament reconstruction (ACL-R) [9, 14, 23]
There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane
The impact of anatomic and nonanatomic ACL-R on osteoarthritis was analyzed in a literature review, and an increased prevalence was found between 23.2% and 43.9% when tunnel placement was nonanatomical after 10 years of follow-up [28]
Summary
Cartilage degeneration at different sites of the knee occurs after anterior cruciate ligament reconstruction (ACL-R) [9, 14, 23]. Higher body mass index (BMI), meniscal tears, and technical errors may accelerate cartilage degeneration after primary ACL-R [11, 19]. Degenerative change of normal cartilage was found in 45% of the entire study cohort [4] In contrast to these findings after primary ACL-R, the current study focused on a special group of patients who had received a second arthroscopy due to failed ACLR. Nonanatomical tunnel placement causes revision of failed ACL-R in 22–79% of the cases [7, 11, 12, 29, 33]. Significant acceleration of cartilage degeneration after failed ACL-R has been reported [2, 22, 24]
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