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Tomihara T, Hashimoto Y, Okazaki S, Nishino K, Taniuchi M, Takigami J, Tsumoto S, Katsuda H. Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2024; 32:1384-1395. [PMID: 38558484 DOI: 10.1002/ksa.12144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Sport Sciences, Osaka University of Health and Sport Sciences, Sennan-gun, Japan
| | - Shiro Okazaki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | | | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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Hurmuz M, Ionac M, Hogea B, Miu CA, Tatu F. Osteoarthritis Development Following Meniscectomy vs. Meniscal Repair for Posterior Medial Meniscus Injuries: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:569. [PMID: 38674215 PMCID: PMC11052089 DOI: 10.3390/medicina60040569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aims to evaluate critically and synthesize the existing literature on the outcomes of meniscectomy versus meniscal repair for posterior medial meniscus injuries, with a focus on osteoarthritis (OA) development. We sought to assess the incidence of OA following both treatment modalities, compare functional outcomes post-treatment, and identify factors influencing treatment choice, providing evidence-based recommendations for clinical decision-making. A comprehensive search strategy was employed across PubMed, Scopus, and Embase up until December 2023, adhering to PRISMA guidelines. The primary outcomes included OA development, functional knee outcomes, and quality of life measures. Six studies met the inclusion criteria, encompassing 298 patients. The systematic review revealed a significant association between meniscal repair and decreased progression of OA compared to meniscectomy. Meniscectomy patients demonstrated a 51.42% progression rate towards OA, significantly higher than the 21.28% observed in meniscal repair patients. Functional outcomes, as measured by the International Knee Documentation Committee (IKDC) and Lysholm scores, were notably better in the repair group, with average scores of 74.68 (IKDC) and 83.78 (Lysholm) compared to 67.55 (IKDC) and 74.56 (Lysholm) in the meniscectomy group. Furthermore, the rate of complete healing in the repair group was reported at 71.4%, as one study reported, indicating a favorable prognosis for meniscal preservation. However, these pooled data should be interpreted with consideration to the heterogeneity of the analyzed studies. Meniscal repair for posterior medial meniscus injuries is superior to meniscectomy in preventing OA development and achieving better functional outcomes and quality of life post-treatment. These findings strongly suggest the adoption of meniscal repair as the preferred treatment modality for such injuries, emphasizing the need for a paradigm shift in clinical practice towards preserving meniscal integrity to optimize patient outcomes.
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Affiliation(s)
- Mihai Hurmuz
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Mihai Ionac
- Department X, Discipline of Vascular Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Bogdan Hogea
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Profesor Universitar Doctor Teodor Șora Research Centre, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Catalin Adrian Miu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
| | - Fabian Tatu
- Department XV, Discipline of Orthopedics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (C.A.M.); (F.T.)
- Orthopedics Unit, “Victor Popescu” Emergency Military Hospital, Gheorghe Lazar Street 2, 300080 Timisoara, Romania
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Erard J, Cance N, Shatrov J, Fournier G, Gunst S, Ciolli G, Porcelli P, Lustig S, Servien E. Delaying ACL reconstruction is associated with increased rates of medial meniscal tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4458-4466. [PMID: 37486367 DOI: 10.1007/s00167-023-07516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. METHODS Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%). RESULTS Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). CONCLUSION Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
| | - Nicolas Cance
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Gaspard Fournier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Stanislas Gunst
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Gianluca Ciolli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Via Della Pineta Sacchetti, 217, 00168, Rome, Italy
| | - Pasquale Porcelli
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Orthopaedic and Traumatology Department, Centro Traumatologico Ortopedico, Via Gianfranco Zuretti, 29, 10126, Turin, TO, Italy
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- IFSTTAR, Univ Lyon, Claude Bernard Lyon 1 University, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
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Reist H, Vacek PM, Endres N, Tourville TW, Failla M, Geeslin A, Geeslin M, Borah A, Krug M, Choquette R, Toth M, Beynnon BD. Risk Factors for Concomitant Meniscal Injury With Sport-Related Anterior Cruciate Ligament Injury. Orthop J Sports Med 2023; 11:23259671231196492. [PMID: 37693810 PMCID: PMC10492489 DOI: 10.1177/23259671231196492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Previous studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors. Purpose To identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury. Study Design Cross-sectional study; Level of evidence, 3. Methods This study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted. Results Concomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci. Conclusion Measures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.
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Affiliation(s)
- Hailee Reist
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Nathan Endres
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Mathew Failla
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Andrew Geeslin
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew Geeslin
- Department of Radiology, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Andy Borah
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mickey Krug
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rebecca Choquette
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mike Toth
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D. Beynnon
- Department of Orthopedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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Lv H, Li W, Wang Y, Chen W, Yan X, Yuwen P, Hou Z, Wang J, Zhang Y. Prediction model for tibial plateau fracture combined with meniscus injury. Front Surg 2023; 10:1095961. [PMID: 37396296 PMCID: PMC10312001 DOI: 10.3389/fsurg.2023.1095961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To investigate a prediction model of meniscus injury in patients with tibial plateau fracture. Methods This retrospective study enrolled patients with tibial plateau fractures who were treated in the Third Hospital of Hebei Medical University from January 1, 2015, to June 30, 2022. Patients were divided into a development cohort and a validation cohort based on the time-lapse validation method. Patients in each cohort were divided into a group with meniscus injury and a group without meniscus injury. Statistical analysis with Student's t-test for continuous variables and chi square test for categorical variables was performed for patients with and without meniscus injury in the development cohort. Multivariate logistic regression analysis was used to screen the risk factors of tibial plateau combined with meniscal injury, and a clinical prediction model was constructed. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility [decision analysis curves (DCA)]. The model was validated internally using bootstrapping and externally by calculating their performance in a validation cohort. Results Five hundred patients (313 [62.6%] males, 187 [37.4%] females) with a mean age of 47.7 ± 13.8 years were eligible and were divided into development (n = 262) and validation (n = 238) cohorts. A total of 284 patients had meniscus injury, including 136 in the development cohort and 148 in the validation cohort We identified high-energy injuries as a risk factor (OR = 1.969, 95%CI 1.131-3.427). Compared with blood type A, patients with blood type B were more likely to experience tibial plateau fracture with meniscus injury (OR = 2.967, 95%CI 1.531-5.748), and office work was a protective factor (OR = 0.279, 95%CI 0.126-0.618). The C-index of the overall survival model was 0.687 (95% CI, 0.623-0.751). Similar C-indices were obtained for external validation [0.700(0.631-0.768)] and internal validation [0.639 (0.638-0.643)]. The model was adequately calibrated and its predictions correlated with the observed outcomes. The DCA curve showed that the model had the best clinical validity when the threshold probability was 0.40 and 0.82. Conclusions Patients with blood type B and high-energy injuries are more likely to have meniscal injury. This may help in clinical trial design and individual clinical decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, ShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, ShijiazhuangChina
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Tomihara T, Hashimoto Y, Takahashi S, Taniuchi M, Takigami J, Tsumoto S, Shimada N. Analyses of associated factors with concomitant meniscal injury and irreparable meniscal tear at primary anterior cruciate ligament reconstruction in young patients. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 32:12-17. [PMID: 37206084 PMCID: PMC10189348 DOI: 10.1016/j.asmart.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Although several factors related to the concomitant meniscal injury at anterior cruciate ligament reconstruction (ACL-R) have been investigated in a general population, few studies have identified the risk factors of meniscal tear severity in young patients in which the majority of ACL tears occur. The purpose of this study was to analyze the associated factors with meniscal injury and irreparable meniscal tear and the timeline for medial meniscal injury at ACL-R in young patients. Methods A retrospective analysis of young patients (13 to 29 years of age) who underwent ACL-R by a single surgeon from 2005 to 2017 was conducted. Predictor variables (age, sex,body mass index [BMI], time from injury to surgery [TS], and pre-injury Tegner activity level) for meniscal injury and irreparable meniscal tear were analyzed with multivariate logistic. Results Four hundred and seventy-three consecutive patients with an average of 31.2 months post-operative follow-up were enrolled in this study. The risk factors for medial meniscus injury were TS (<= 3 months) (odds ratio [OR], 3.915; 95% CI, 2.630-5.827; P < .0001) and higher BMI (OR, 1.062; 95% CI, 1.002-1.125; P = 0.0439). The presence of irreparable medial meniscal tears correlated with higher BMI (OR, 1.104; 95% CI, 1.011-1.205; P = 0.0281). Conclusion An increased time from ACL tear to surgery of 3 months was strongly associated with an increased risk of medial meniscus injury, but not related to irreparable medial meniscal tear at primary ACL reconstruction in young patients. Level of Evidence Level IV.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
- Corresponding author.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatoshi Taniuchi
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
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Giordano L, Maffulli N, Carimati G, Morenghi E, Volpi P. Increased Time to Surgery After Anterior Cruciate Ligament Tear in Female Patients Results in Greater Risk of Medial Meniscus Tear: A Study of 489 Female Patients. Arthroscopy 2023; 39:613-622. [PMID: 36309227 DOI: 10.1016/j.arthro.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This study assessed the incidence of meniscal tears in anterior cruciate ligament (ACL)-deficient knees, considering the time between injury and reconstruction in a large sample of female patients. Furthermore, we evaluated whether the rate of meniscal repair or meniscectomy was affected by age and body mass index (BMI). METHODS The medical records of 489 patients who underwent ACL-reconstructive surgery between January 2011 and April 2021 were analyzed to collect data on the prevalence of meniscal tears, surgical timing, patient age, and BMI. Logistic regression was performed to estimate the association between the prevalence of meniscal tears and the independent variables of surgical timing, age, and BMI. RESULTS Between 24 and 60 months after their injury, female patients showed a statistically significant increase in the presence of associated meniscal lesions when compared with ACL reconstruction performed earlier (odds ratio [OR] of 3.11; 95% 1.06-9.10 confidence interval [CI]), especially for medial meniscal tears, with an OR of 1.94 (95% CI 1.23-3.05, P = .004) between 12 and 24 months. There is a statistically significant difference after 12 months in the rate of meniscal suturing for medial meniscus tears (OR 3.30; CI 1.37-7.91 P = .007). Increasing age was associated with a greater prevalence of meniscal tears up to 30-50 years, but there was no clear association between BMI and associated lesions other than a greater rate of meniscectomies. CONCLUSIONS In female patients who experienced an ACL injury, a delay in surgery greater than 12 months is associated with a gradual increase in the risk of nonrepairable medial meniscal tear; this risk becomes statistically significant after 24 months. A high BMI does not seem to have relevance in the onset of associated lesions in women but results in a greater rate of meniscectomies compared with meniscal sutures, whereas age between 30 and 50 years is associated with a greater risk of associated injuries. LEVEL OF EVIDENCE III, retrospective comparative prognostic trial.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom; School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, United Kingdom.
| | - Giulia Carimati
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
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Freshman RD, Truong NM, Cevallos N, Lansdown DA, Feeley BT, Ma CB, Zhang AL. Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07249-z. [PMID: 36459171 DOI: 10.1007/s00167-022-07249-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To utilise a large cross-sectional database to analyse the effects of time duration between diagnosis of anterior cruciate ligament (ACL) tear and ACL reconstruction (ACLR) on concomitant procedures performed and subsequent surgery within 2 years. METHODS An analysis from 2015 to 2018 was performed using the Mariner PearlDiver Patient Records Database. Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-10) codes identified patients with a diagnosis of ACL tear who underwent subsequent ACLR. Patients were stratified in biweekly and bimonthly increments based on the time duration between initial diagnosis of ACL tear and surgical treatment. Chi-squared analysis was used to compare categorical variables, and trend analysis was performed with Cochran-Armitage independence testing. RESULTS Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2 months of injury diagnosis. Patients aged 10-19 were most likely to undergo surgery within 2 months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2 months to > 6 months, rates of concomitant meniscectomy increased from 9.1% to 20.5% (P < 0.0001). The overall 2-year subsequent surgery rate was 5.3%. The incidence of revision ACLR was highest for patients who underwent surgery > 6 months after diagnosis (P < 0.0001), whilst the incidence of ipsilateral lysis of adhesions and manipulation under anaesthesia (MUA) was highest for patients who underwent surgery < 2 months after diagnosis (P < 0.0001). ACLR at 6-8 weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery. CONCLUSION The majority of patients undergo ACL reconstruction within 2 months of initial ACL tear diagnosis. Delayed surgery greater than 6 months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2 years, but immediate surgery may increase risk for knee arthrofibrosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA.
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA
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