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Sedgwick MJ, Saunders C, Getgood AM. Systematic Review and Meta-analysis of Clinical Outcomes Following Meniscus Repair in Patients 40 Years and Older. Orthop J Sports Med 2024; 12:23259671241258974. [PMID: 39131093 PMCID: PMC11311169 DOI: 10.1177/23259671241258974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/01/2024] [Indexed: 08/13/2024] Open
Abstract
Background Meniscal repair has been associated with long-term benefit in patients compared with meniscectomy. As a generalization, meniscal repair in older patients is less likely to be successful, leading to reduced adoption of meniscal repair compared with younger patients. Purpose To establish the clinical performance of meniscal repair in "older" patients (age, ≥40 years) and compare it with performance in "younger" patients (age, <40 years). Study Design Systematic review; Level of evidence, 4. Methods A systematic literature review was performed in September 2021 using Embase and PubMed to identify published English-language studies that reported on a meniscal repair in >5 patients aged ≥40 years. Outcomes of interest were success/failure rate (as defined by the study), revision meniscal procedure rate, and patient-reported outcomes. Meta-analyses were used to synthesize outcomes across all studies in older patients. Meta-analyses were also used to compare outcomes between older and younger patients across studies, providing data on both age groups. Results Fourteen studies were identified. Meniscal repair in older patients was determined to have a failure rate of 12% (95% CI, 7.3% to 19.4%) and a revision meniscal procedure rate of 9.8% (95% CI, 6.2% to 15.0%). The postoperative Lysholm score was 86.7 (95% CI, 81.7 to 91.7). No statistically significant differences were observed between older and younger patients in failure rate (relative risk [RR], 0.73 [95% CI, 0.44 to 1.21]; P = .2205), revision meniscal procedure rate (RR, 0.69 [95% CI, 0.41 to 1.16]; P = .1613), or Lysholm scores (mean difference, 2.3 [95% CI, -4.7 to 9.2]; P = .5278, 4 studies). Conclusion Meniscal repair in selected patients aged ≥40 years resulted in good success rates and patient-reported outcome measures, which appear similar to those reported for patients aged <40 years. Therefore, meniscal repairs can be performed in at least a specific portion of "older" patients, and age per se should not be the sole determining factor in whether to perform a meniscal repair.
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Affiliation(s)
| | | | - Alan M.J. Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
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Jackson GR, Meade J, Yu Z, Young B, Piasecki DP, Fleischli JE, Parisien RL, Trofa DP, Saltzman BM. Outcomes and failure rates after revision meniscal repair: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1557-1562. [PMID: 35477793 DOI: 10.1007/s00264-022-05413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to determine the outcomes and failure rates for revision meniscus repairs in patients with re-tears after primary repair failure. METHODS A literature search was conducted using PubMed and Embase with the terms "Meniscus," "Meniscal," "Revised," and "Revision." The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included four articles (79 patients). The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analysis, and case reports. RESULTS Four comparative studies with 79 patients (53 males, 26 females) with a mean age of 23.9 ± 6.4 years treated with a revision meniscus repair were included in the final analysis. Within this analysis, we found a failure rate of 25.3% (20 of 79 patients). Of these failed repairs, 30.95% (13 of 42) were of the medial meniscus, and 18.9% (7 of 37) were of the lateral meniscus. In the four articles, the postoperative Tegner sports activity score was found to be 6.1 ± 1.6 (range, 2 to 10). The post-operative Lysholm score was reported in three articles (45 patients). At a mean follow-up of 58.3 ± 23.9 months, the mean post-operative Lysholm score was 89.1 ± 7.6 (range, 38 to 100). The Coleman score for the included articles ranged between 52 and 59. CONCLUSION This analysis found that revision meniscus repairs in patients with re-tears after primary repair failure result in clinical outcomes similar to that of primary repairs.
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Affiliation(s)
- Garrett R Jackson
- School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
| | - Joshua Meade
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Bradley Young
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Dana P Piasecki
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - James E Fleischli
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina, Charlotte, NC, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Queens, NY, USA
| | - David P Trofa
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Bryan M Saltzman
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA. .,OrthoCarolina, Charlotte, NC, USA.
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Isolated revision meniscal repair - failure rates, clinical outcome, and patient satisfaction. BMC Musculoskelet Disord 2018; 19:446. [PMID: 30577789 PMCID: PMC6303960 DOI: 10.1186/s12891-018-2368-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/03/2018] [Indexed: 01/11/2023] Open
Abstract
Background Failure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable knee joints. Methods A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction. Results A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 (± 4.2) with a range of 90–100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the outcome. Conclusion In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair is worthwhile in selected cases in order to save as much meniscal tissue as possible.
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Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients. Knee 2018; 25:1142-1150. [PMID: 30414793 DOI: 10.1016/j.knee.2018.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/15/2018] [Accepted: 09/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40 years or older. METHODS A systematic search was performed, and 225 meniscus repair outcome studies on adults were identified in the English literature. Included studies reported either individual patient data with at least one patient age ≥40 years or summary data with all patients' age ≥40 years. Failure rates were determined based on previously reported risk factors (regardless of age) including concomitant anterior cruciate ligament (ACL) reconstruction (ACLR), tear location, and tear pattern. RESULTS Meniscus repair outcomes for 148 patients from 11 studies were included (125 inside-out repairs and 23 all-inside repairs). The overall failure rate was 10% (15/148) and ranged from 0 to 23% in individual studies with more than one patient age ≥40 years. One comparative study of patients over versus under age 40 years was identified, with no difference in failure rates between groups. Most tears were peripheral tears with avascular extension (nine-percent overall failure rate) or without avascular extension (nine-percent failure rate). Among studies that reported tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were nine percent and complex and/or horizontal tears were 23%. Repairs with concomitant ACL reconstruction had a five-percent overall failure rate versus 15% in ACL intact patients. CONCLUSION Meniscus repair failure rates in patients age 40 years and older are comparable to rates quoted for younger patients. LEVEL OF EVIDENCE Level IV. Systematic review of Level III and IV studies.
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Krych AJ, Reardon P, Sousa P, Levy BA, Dahm DL, Stuart MJ. Clinical Outcomes After Revision Meniscus Repair. Arthroscopy 2016; 32:1831-7. [PMID: 27132771 DOI: 10.1016/j.arthro.2016.01.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To (1) report outcomes for patients who underwent revision meniscal repair and (2) define both clinical and surgical risk factors for recurrent failure. METHODS The records of all patients who underwent revision meniscal repair between 1997 and 2012 were retrospectively reviewed. Surgical technique of primary and revision meniscus repair was detailed, and tears were characterized by type and location. Clinical examination and International Knee Documentation Committee (IKDC) and Tegner scores were used to determine outcomes after revision meniscus repair. Radiographs were reviewed and graded for degenerative changes. Risk factors for failure were analyzed. RESULTS Thirty-four patients (24 male/10 female) with an average age of 22 ± 6 years (range, 14 to 38) were included in this study. Twelve lateral menisci and 22 medial meniscal repairs were revised at mean 25 ± 20 months (range, 2 to 76) after primary repair for 11 simple, 9 bucket-handle, and 14 complex tear patterns. Twenty-one tears occurred in the red-red zone and 13 in the red-white zone. At 72 ± 56-month follow-up (range, 2 to 17 years), 7 (21%) cases had documented failure of revision repairs and underwent subsequent partial meniscectomy. Mean Tegner score for all patients was 6.2 ± 1.5 (range, 3 to 9) and IKDC score was 84.8 ± 13.1 (range, 51.7 to 100) at final follow-up. Affected side joint space on radiographs remained stable from a baseline of 4.26 ± 0.88 mm to a final of 4.01 ± 0.84 mm. Multivariable regression identified younger patient age as an independent risk factor for failed revision meniscal repair (P = .01). CONCLUSIONS In this study of select revision meniscus repairs, 79% of patients were pain free, without any mechanical symptoms or additional surgeries at a mean of 6 years after revision repair. Younger patients may be at higher risk of failure of the revision meniscus repair. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
| | - Pat Reardon
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Paul Sousa
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Diane L Dahm
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Stuart
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Shieh AK, Edmonds EW, Pennock AT. Revision Meniscal Surgery in Children and Adolescents: Risk Factors and Mechanisms for Failure and Subsequent Management. Am J Sports Med 2016; 44:838-43. [PMID: 26818451 DOI: 10.1177/0363546515623511] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The mechanisms of failure and risk factors for failed meniscal surgery in children and adolescents have not been well described. PURPOSE To investigate the risk factors, mechanisms of failure, and subsequent operative management for revision meniscal surgery in a pediatric population, as well as to identify the local incidence of failed meniscal surgery. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All patients younger than 20 years who had arthroscopic management for meniscal injuries at a single institution between 2008 and 2012 underwent retrospective review. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscal surgery. RESULTS Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 primary repairs, 149 primary partial meniscectomies, and 46 discoid saucerizations ± stabilization. At a mean of 40 months (range, 19-62 months) after surgery, 13% of all menisci required a revision procedure. The primary repair cohort had the highest failure rate (18%), followed by the primary discoid saucerization cohort (15%) and the partial meniscectomy cohort (7%). Multivariate analysis indicated that meniscal repair was predictive of retear (odds ratio, 2.04 [95% CI, 1.01-4.1]; P = .046), and children with an open physis and a bucket-handle tear had the highest retear rate of 46% (P = .039). Independent variables shown to have no significant relationship to revision meniscal surgery included age, sex, body mass index, extremity side, laterality (medial-lateral), time to repair, tear location, and associated ligament reconstruction. The most common indication for revision surgery was an acute reinjury during intense physical activity. Revision procedures were performed at a mean of 14 months after the index procedure, and the majority of failures (83%) were identified within 1 year. Of patients undergoing a revision surgery, 44% underwent a further debridement, whereas 56% underwent a repair. CONCLUSION The success rate of meniscal surgery is 87% in children and adolescents. The revision rate was higher when repair was attempted in the index procedure, particularly in those children with open physes and bucket-handle tears. Most failures are the result of an acute reinjury within 1 year, and nearly half will require debridement of the retorn meniscus.
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Affiliation(s)
- Alvin K Shieh
- University of California, San Diego, La Jolla, California, USA
| | - Eric W Edmonds
- University of California, San Diego, La Jolla, California, USA Rady Children's Hospital and Health Center, San Diego, California, USA
| | - Andrew T Pennock
- University of California, San Diego, La Jolla, California, USA Rady Children's Hospital and Health Center, San Diego, California, USA
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Cardello P, Gigli C, Ricci A, Chiatti L, Voglino N, Pofi E. Retears of postoperative knee meniscus: findings on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) by using low and high field magnets. Skeletal Radiol 2009; 38:149-56. [PMID: 18846372 DOI: 10.1007/s00256-008-0600-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 09/12/2008] [Accepted: 09/12/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the diagnostic performance of magnetic resonance (MR) obtained with intra-articular contrast medium in the evaluation of recurrent meniscal tears using low-field extremity-only and high-field whole-body magnets. MATERIALS AND METHODS Postoperative standard MR examinations and MR arthrographies of 95 knees were reviewed. Patients experiencing pain and disability after meniscal repair underwent standard MR and MR arthrography (Gadoterate meglumine 0.0025 mmol/ml) on both a 0.2-T and 1.5-T magnet. In 52 of 95 patients, second-look arthroscopy was performed; in the remaining 43 of 95 patients, clinical follow-up was used as the standard of reference. Sensitivity, specificity, positive and negative predictive values as well as accuracy of MRI/MR arthrographic signs as meniscal morphologic changes and the presence of contrast medium tracking into the tear at T1- and T2-weighted sequences in the detection of recurrent meniscal tears were determined. RESULTS All MR and MR arthrograpic signs were sensitive in the detection of recurrent tears (range 80-91%). Abnormal meniscal morphology had low specificity [26% (13/50)] for both the 0.2-T and 1.5-T scanner, whereas accuracy was 55% (52/95) and 57% (54/95), respectively. The presence of contrast medium within the meniscus substance on T2-weighted images had higher value of specificity [84% (42/50)] and accuracy [84% (80/95)] by using low field strength magnet than by using high field strength magnet [74% (37/50) and 81% (77/95), respectively]. Whereas, the increased intrameniscal signal intensity extending to the meniscal surface at T1-weighted sequences after intra-articular contrast medium administration had lower specificity and accuracy on 0.2-T images [84% (42/50) and 82% (78/95), respectively] than on 1.5-T images [90% (45/50) and 88% (84/95), respectively]. CONCLUSION A diagnosis of recurrent meniscal tear in a previously arthroscopically repaired meniscus can be made both on 0.2-T and 1.5-T magnets on the basis of increased signal on T2-weighted and T1-weighted images in the presence of intra-articular contrast material.
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Affiliation(s)
- Paolo Cardello
- Department of Radiodiagnostic, Belcolle Hospital, Street Sammartinese snc, Viterbo, Italy.
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Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Am J Sports Med 2008; 36:1283-9. [PMID: 18319351 DOI: 10.1177/0363546508314411] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Isolated meniscal tears in the skeletally immature patient are infrequent but well-recognized injuries. Although few studies have evaluated the pediatric and adolescent population, arthroscopic surgical repair remains the standard of care for patients in this age group with unstable meniscal tears. PURPOSE To review our results of arthroscopic repair of isolated meniscal tears in pediatric and adolescent patients to further define future management of these injuries. STUDY DESIGN Case series; Level of evidence, 4. METHODS The records of all patients 18 years old or younger who underwent isolated meniscal repair between 1990 and 2005 were retrospectively reviewed. Forty-four patients (6 girls, 38 boys) with an average age of 15.8 years (range, 9.9-18.7 years) were included in this study, for a total of 45 isolated meniscal tears. Clinical examinations were performed, International Knee Documentation Committee forms were administered, and Tegner scores were determined at an average of 5.8 years (range, 2.5 months-13.8 years) postoperative follow-up. Three patients were lost to follow-up. RESULTS The clinical success rate of arthroscopic meniscal repair was 80% for simple tears, 68% for displaced bucket-handle tears, and 13% for complex tears. Seventeen menisci (38% overall) failed initial repair at a mean of 17 months (range, 3-61 months) postoperatively and underwent repeat arthroscopic surgery (15 partial meniscectomies, 2 rerepair). The average Tegner and International Knee Documentation Committee scores were 8 (range, 5-9) and 89.4 (range, 79-99), respectively, at the time of final follow-up. Risk factors for failure included complex tears and rim width greater than 3 mm. CONCLUSION Clinically successful repair of an isolated meniscal tear in patients 18 years or younger was variable depending on tear type, with complex tears and rim width 3 mm or greater being negative prognostic factors.
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery, The Sports Medicine Center, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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Frobell RB, Svensson E, Göthrick M, Roos EM. Self-reported activity level and knee function in amateur football players: the influence of age, gender, history of knee injury and level of competition. Knee Surg Sports Traumatol Arthrosc 2008; 16:713-9. [PMID: 18350275 DOI: 10.1007/s00167-008-0509-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 02/08/2008] [Indexed: 12/11/2022]
Abstract
The aim of this study is to investigate if self-reported activity level or knee functions are influenced by subject characteristics, level of competition and history of knee injury. Cross-Sectional study using questionnaires distributed at a personal visit. One hundred and eighty-eight (65 women) amateur football players in 10 football clubs from each division below national level participated in the study. Self-reported Tegner Activity Scale, and the Knee injury and Osteoarthritis Outcome Score (KOOS) are the main outcome measures. Older age, female gender and lower level of competition (football division) were independently associated with lower self-reported Tegner Activity Scale (P < 0.001). Subjects reporting history of knee injury had significantly worse KOOS scores (P < 0.001 for all subscales). In future studies, a clear description of how the Tegner Activity Scale was administered is recommended. We suggest that self-reported Tegner Activity Scale scores should be adjusted for age, gender and level of competition. In amateur football players, KOOS scores do not need adjustment for age and gender.
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Affiliation(s)
- R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden.
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Affiliation(s)
- Scott C Montgomery
- Department of Orthopaedic Surgery, McCue Center, University of Virginia, P.O. Box 800243, Charlottesville, VA 22908, USA.
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