Previous Knee Surgery Is a Risk Factor for Knee Articular Cartilage Lesions Among Athletes at the NFL Combine (SS-29)

Abstract

Introduction Although articular cartilage lesions of the knee are a common finding among elite athletes, the risk factors for these lesions have not been well defined. The purpose of this study was to better define the prevalence of articular cartilage lesions in elite football players undergoing knee MRI at the National Football League (NFL) Combine and to test the hypothesis that previous knee surgery is a risk factor for these lesions. Methods We performed a retrospective review of all NFL Combine participants undergoing knee MRI from 2005 to 2009. A total of 597 players (726 knee MRIs) were reviewed for evidence of articular cartilage disease, classified as absent, chondromalacia, or full-thickness cartilage loss. History of previous knee surgery (including ACL reconstruction, meniscal procedures, and articular cartilage surgery) was recorded for each athlete. Results Full-thickness articular cartilage lesions were seen in 18% of knees and were associated with a history of any previous knee surgery (p<0.001) and specifically, previous meniscectomy (p<0.001). Full-thickness lesions were present in 29% of knees with a previous meniscectomy compared to 14% of knees without previous meniscal surgery (p<0.001). Full-thickness lesions were found in the lateral compartment of 25% of knees with previous partial lateral meniscectomy compared to 5% of knees without such surgery (p<0.001). The effect was also present in the medial compartment where 2% of knees without previous partial medial meniscectomy had full-thickness lesions compared to 7% of knees with previous partial medial meniscectomy (p=0.025). Previous ACL reconstruction was not associated with an increased risk of full-thickness articular cartilage lesions. Conclusion Previous knee surgery is a risk factor for full-thickness cartilage lesions in athletes participating in cutting contact sports such as American football. Partial meniscectomy increases the risk of full-thickness cartilage lesions, particularly in the lateral compartment. Future research should investigate the effect of these lesions on athlete performance and longevity, as well as potential methods of chondral protection such as meniscal repair in this patient cohort. Although articular cartilage lesions of the knee are a common finding among elite athletes, the risk factors for these lesions have not been well defined. The purpose of this study was to better define the prevalence of articular cartilage lesions in elite football players undergoing knee MRI at the National Football League (NFL) Combine and to test the hypothesis that previous knee surgery is a risk factor for these lesions. We performed a retrospective review of all NFL Combine participants undergoing knee MRI from 2005 to 2009. A total of 597 players (726 knee MRIs) were reviewed for evidence of articular cartilage disease, classified as absent, chondromalacia, or full-thickness cartilage loss. History of previous knee surgery (including ACL reconstruction, meniscal procedures, and articular cartilage surgery) was recorded for each athlete. Full-thickness articular cartilage lesions were seen in 18% of knees and were associated with a history of any previous knee surgery (p<0.001) and specifically, previous meniscectomy (p<0.001). Full-thickness lesions were present in 29% of knees with a previous meniscectomy compared to 14% of knees without previous meniscal surgery (p<0.001). Full-thickness lesions were found in the lateral compartment of 25% of knees with previous partial lateral meniscectomy compared to 5% of knees without such surgery (p<0.001). The effect was also present in the medial compartment where 2% of knees without previous partial medial meniscectomy had full-thickness lesions compared to 7% of knees with previous partial medial meniscectomy (p=0.025). Previous ACL reconstruction was not associated with an increased risk of full-thickness articular cartilage lesions. Previous knee surgery is a risk factor for full-thickness cartilage lesions in athletes participating in cutting contact sports such as American football. Partial meniscectomy increases the risk of full-thickness cartilage lesions, particularly in the lateral compartment. Future research should investigate the effect of these lesions on athlete performance and longevity, as well as potential methods of chondral protection such as meniscal repair in this patient cohort.