Location and Progression of Chondral Injuries at the Time of Revision ACL Surgery Varies by Sex

Abstract

The purpose of this study was to quantify progression in of chondral and meniscal injuries between primary and revision ACL surgery. Patients who underwent both index and revision ACL reconstruction between 2000 and 2020 at our institution were identified, and dates of injury and surgery, demographics, and clinical data were obtained from operative reports. Outerbridge grade was recorded in each compartment, along with presence and location of meniscal injury. The frequency of each injury between first and second cases were calculated. Differences in injury and progression were compared over time as well as between patient sex and age. The study included 190 patients (96 female, 93 male). Age at first surgery was 31.7 ± 13.2. Mean time to second injury was 3.3 ± 3.0 years. In total, 116 patients had a new or previous chondral injury (OR= 1.6, 95 CI: 1.2 - 2.1). The medial femoral condyle (31%) and the patella (21%) accounted for the highest proportion of new injury to articular surfaces whereas new injury to menisci was comparable between the medial (25%) and lateral (23%) meniscus. At the time of revision ACLR, females had a high prevalence of chondral injuries to the lateral compartment whereas males had a high prevalence of chondral injury to the medial femoral condyle. The prevalence of new chondral injuries was comparable between sexes, with males having a slightly higher proportion. While time between surgeries, sex, and age had graphical evidence of moderating risk; the effects were small and imprecise. Revision ACL reconstruction carried a 1.6 increase in the odds for new or progressive chondral lesions in our cohort. At the time of revision, females had a relatively higher proportion of lateral-sided chondral injuries whereas males had a relatively higher proportion of medial femoral condyle injuries. The greatest increase in the prevalence of new and progressive lesions were observed in the medial femoral condyle and trochlea. This progression appeared to be moderated by time between surgeries, patient sex, and age; however, the differences were small and imprecise.