Articular and Meniscal Pathology Associated with Primary Anterior Cruciate Ligament Reconstruction

 

 Buy Article Permissions and Reprints

Abstract

Background The abnormal kinematics, contact pressures, and repeated episodes of instability observed in chronic anterior cruciate ligament (ACL) deficiency suggest that these patients may be predisposed to early degenerative changes and associated pathologies such as meniscal tears and chondral injury. Injury to the cartilage and associated structures at the time of ACL rupture, in combination with the inflammatory mediators released at the time of injury, may create irreversible damage to the knee despite restoration of normal knee kinematics with an ACL reconstruction.

Hypothesis Patients undergoing acute ACL reconstruction have a higher incidence of lateral meniscal tears and less severe chondral changes when compared with patients undergoing late ACL reconstruction. Older patients likely have a higher incidence of chondral and meniscal pathology compared with younger patients.

Methods A retrospective chart review of a single surgeon's ACL practice over 20 years was performed. A surgical data packet was used to record patient demographics, location, grade, and number of chondral injuries as well as location and pattern of meniscal injuries at the time of ACL reconstruction. Patients (N = 709) were divided into three subgroups according to their time from injury to surgery; acute (less than 4 weeks, N = 121), subacute (4 to 8 weeks, N = 146), and chronic (8 weeks or more, N = 442).

Results Older patients had a higher incidence of more severe chondral grade and number of chondral injuries at the time of ACL reconstruction. Patients undergoing surgery more than 8 weeks after injury had a statistically significant more severe chondral grade in the medial compartment when compared with those that had surgery less than 8 weeks after injury. A similar observation was not found in the lateral compartment. With regard to meniscal pathology, full-thickness medial meniscal tears were likely to be bucket-type tears regardless of the chronicity of the injury. Similarly, full-thickness lateral meniscal tears were more often flap-type tears independent of the time interval between injury and surgery. Partial-thickness tears were common both medially and laterally.

Conclusions Patient's age and chronicity of ACL tear greater than 8 weeks are both significant factors in medial compartment chondral pathology. Patients with delayed reconstruction may have greater associated pathology.

• References

• 1 Cohen SB, Sekiya JK. Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med 2007; 26 (4) 597-605
  CrossrefPubMedGoogle Scholar
• 2 Yamamoto Y, Hsu WH, Fisk JA, Van Scyoc AH, Miura K, Woo SL. Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test. J Orthop Res 2006; 24 (5) 967-973
  CrossrefPubMedGoogle Scholar
• 3 Monaco E, Ferretti A, Labianca L , et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 2012; 20 (5) 870-877
  CrossrefPubMedGoogle Scholar
• 4 Zantop T, Petersen W. Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique. Arch Orthop Trauma Surg 2008; 128 (11) 1287-1294
  CrossrefPubMedGoogle Scholar
• 5 Kanamori A, Sakane M, Zeminski J, Rudy TW, Woo SL. In-situ force in the medial and lateral structures of intact and ACL-deficient knees. J Orthop Sci 2000; 5 (6) 567-571
  CrossrefPubMedGoogle Scholar
• 6 Musahl V, Citak M, O'Loughlin PF, Choi D, Bedi A, Pearle AD. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 2010; 38 (8) 1591-1597
  CrossrefPubMedGoogle Scholar
• 7 Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001; 29 (2) 226-231
  CrossrefPubMedGoogle Scholar
• 8 Cerabona F, Sherman MF, Bonamo JR, Sklar J. Patterns of meniscal injury with acute anterior cruciate ligament tears. Am J Sports Med 1988; 16 (6) 603-609
  CrossrefPubMedGoogle Scholar
• 9 Daniel B. Arthroscopically assisted reconstruction of the anterior cruciate ligament a follow-up report. The Journal of Bone and Joint Surgery (American) 2001; 83 (9) 1329-1332
  PubMedGoogle Scholar
• 10 Giove TP, Miller III SJ, Kent BE, Sanford TL, Garrick JG. Non-operative treatment of the torn anterior cruciate ligament. J Bone Joint Surg Am 1983; 65 (2) 184-192
  PubMedGoogle Scholar
• 11 Hawkins RJ, Misamore GW, Merritt TR. Followup of the acute nonoperated isolated anterior cruciate ligament tear. Am J Sports Med 1986; 14 (3) 205-210
  CrossrefPubMedGoogle Scholar
• 12 McDaniel Jr WJ, Dameron Jr TB. The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res 1983; 172 (172) 158-163
  PubMedGoogle Scholar
• 13 Noyes FR, Bassett RW, Grood ES, Butler DL. Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 1980; 62 (5) 687-695 , 757
  CrossrefPubMedGoogle Scholar
• 14 Walla DJ, Albright JP, McAuley E, Martin RK, Eldridge V, El-Khoury G. Hamstring control and the unstable anterior cruciate ligament-deficient knee. Am J Sports Med 1985; 13 (1) 34-39
  CrossrefPubMedGoogle Scholar
• 15 Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999; 27 (3) 143-156
  CrossrefPubMedGoogle Scholar
• 16 O'Neill DB. Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am 1996; 78 (6) 803-813
  Google Scholar
• 17 Irie K, Uchiyama E, Iwaso H. Intraarticular inflammatory cytokines in acute anterior cruciate ligament injured knee. Knee 2003; 10 (1) 93-96
  CrossrefPubMedGoogle Scholar
• 18 Szczodry M, Coyle CH, Kramer SJ, Smolinski P, Chu CR. Progressive chondrocyte death after impact injury indicates a need for chondroprotective therapy. Am J Sports Med 2009; 37 (12) 2318-2322
  CrossrefPubMedGoogle Scholar
• 19 Dye SF, Wojtys EM, Fu FH, Fithian DC, Gillquist I. Factors contributing to function of the knee joint after injury or reconstruction of the anterior cruciate ligament. Instr Course Lect 1999; 48: 185-198
  PubMedGoogle Scholar
• 20 Fowler PJ, Regan WD. The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med 1987; 15 (4) 321-325
  CrossrefPubMedGoogle Scholar
• 21 Lynch MA, Henning CE, Glick Jr KR. Knee joint surface changes. Long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop Relat Res 1983; 172 (172) 148-153
  PubMedGoogle Scholar
• 22 Satku K, Kumar VP, Ngoi SS. Anterior cruciate ligament injuries. To counsel or to operate?. J Bone Joint Surg Br 1986; 68 (3) 458-461
  PubMedGoogle Scholar
• 23 Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW. MOON Consortium and the MARS Group. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med 2011; 39 (9) 1889-1893
  CrossrefPubMedGoogle Scholar
• 24 Cipolla M, Scala A, Gianni E, Puddu G. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc 1995; 3 (3) 130-134
  CrossrefPubMedGoogle Scholar
• 25 Tandogan RN, Taşer Ö, Kayaalp A , et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 2004; 12 (4) 262-270
  Google Scholar
• 26 Bonamo JJ, Fay C, Firestone T. The conservative treatment of the anterior cruciate deficient knee. Am J Sports Med 1990; 18 (6) 618-623
  CrossrefPubMedGoogle Scholar
• 27 Fetto JF, Marshall JL. The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 1980; 147 (147) 29-38
  PubMedGoogle Scholar
• 28 Keene GCR, Bickerstaff D, Rae PJ, Paterson RS. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 1993; 21 (5) 672-679
  CrossrefPubMedGoogle Scholar
• 29 Smith III JP, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 2001; 29 (4) 415-419
  CrossrefPubMedGoogle Scholar
• 30 Warren RF, Levy IM. Meniscal lesions associated with anterior cruciate ligament injury. Clin Orthop Relat Res 1983; 172 (172) 32-37
  PubMedGoogle Scholar
• 31 Wickiewicz TL. Meniscal injuries in the cruciate-deficient knee. Clin Sports Med 1990; 9 (3) 681-694
  CrossrefPubMedGoogle Scholar
• 32 Jones HP, Appleyard RC, Mahajan S, Murrell GA. Meniscal and chondral loss in the anterior cruciate ligament injured knee. Sports Med 2003; 33 (14) 1075-1089
  CrossrefPubMedGoogle Scholar
• 33 Outerbridge RE. The etiology of chondromalacia patellae. 1961. Clin Orthop Relat Res 2001; (389) 5-8
  PubMedGoogle Scholar
• 34 Hardin GT, Bach Jr BR, Bush-Joseph CA, Farr J. Endoscopic single-incision anterior cruciate ligament reconstruction using patellar tendon autograft: surgical technique. 1992 [classical article]. J Knee Surg 2003; 16 (3) 135-144 , discussion 145–147
  PubMedGoogle Scholar
• 35 Andersson C, Odensten M, Gillquist J. Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period. Clin Orthop Relat Res 1991; 264 (264) 255-263
  PubMedGoogle Scholar
• 36 Andersson C, Odensten M, Good L, Gillquist J. Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament. A randomized study with long-term follow-up. J Bone Joint Surg Am 1989; 71 (7) 965-974
  PubMedGoogle Scholar
• 37 Chick RR, Jackson DW. Tears of the anterior cruciate ligament in young athletes. J Bone Joint Surg Am 1978; 60 (7) 970-973
  PubMedGoogle Scholar
• 38 Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 1994; 22 (5) 632-644
  CrossrefPubMedGoogle Scholar
• 39 Engebretsen L, Tegnander A. Short-term results of the nonoperated isolated anterior cruciate ligament tear. J Orthop Trauma 1990; 4 (4) 406-410
  PubMedGoogle Scholar
• 40 DeHaven KE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 1980; 8 (1) 9-14
  CrossrefPubMedGoogle Scholar
• 41 Maffulli N, Binfield PM, King JB, Good CJ. Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases. J Bone Joint Surg Br 1993; 75 (6) 945-949
  PubMedGoogle Scholar
• 42 Indelicato PA, Bittar ES. A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res 1985; 198 (198) 77-80
  PubMedGoogle Scholar
• 43 Woods GW, Chapman DR. Repairable posterior menisco-capsular disruption in anterior cruciate ligament injuries. Am J Sports Med 1984; 12 (5) 381-385
  CrossrefPubMedGoogle Scholar
• 44 Andriacchi TP, Briant PL, Bevill SL, Koo S. Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 2006; 442: 39-44
  CrossrefPubMedGoogle Scholar
• 45 Gao B, Zheng NN. Alterations in three-dimensional joint kinematics of anterior cruciate ligament-deficient and -reconstructed knees during walking. Clin Biomech (Bristol, Avon) 2010; 25 (3) 222-229
  CrossrefPubMedGoogle Scholar
• 46 Teeple E, Elsaid KA, Fleming BC , et al. Coefficients of friction, lubricin, and cartilage damage in the anterior cruciate ligament-deficient guinea pig knee. J Orthop Res 2008; 26 (2) 231-237
  CrossrefPubMedGoogle Scholar
• 47 Van de Velde SK, Bingham JT, Hosseini A , et al. Increased tibiofemoral cartilage contact deformation in patients with anterior cruciate ligament deficiency. Arthritis Rheum 2009; 60 (12) 3693-3702
  CrossrefPubMedGoogle Scholar
• 48 Felix NA, Paulos LE. Current status of meniscal transplantation. Knee 2003; 10 (1) 13-17
  CrossrefPubMedGoogle Scholar
• 49 Bach Jr BR, Jones GT, Hager CA, Sweet FA, Luergans S. Arthrometric results of arthroscopically assisted anterior cruciate ligament reconstruction using autograft patellar tendon substitution. Am J Sports Med 1995; 23 (2) 179-185
  CrossrefPubMedGoogle Scholar
• 50 Bach Jr BR, Jones GT, Sweet FA, Hager CA. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med 1994; 22 (6) 758-767
  CrossrefPubMedGoogle Scholar
• 51 Bach Jr BR, Levy ME, Bojchuk J, Tradonsky S, Bush-Joseph CA, Khan NH. Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow-up evaluation. Am J Sports Med 1998; 26 (1) 30-40
  CrossrefPubMedGoogle Scholar
• 52 Bach Jr BR, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med 1998; 26 (1) 20-29
  CrossrefPubMedGoogle Scholar
• 53 Fox JA, Pierce M, Bojchuk J, Hayden J, Bush-Joseph CA, Bach Jr BR. Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft. Arthroscopy 2004; 20 (8) 787-794
  PubMedGoogle Scholar
• 54 Novak PJ, Bach Jr BR, Hager CA. Clinical and functional outcome of anterior cruciate ligament reconstruction in the recreational athlete over the age of 35. Am J Knee Surg 1996; 9 (3) 111-116
  PubMedGoogle Scholar