Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

Michella H. Hagmeijer, Mario Hevesi, Vishal S. Desai, Thomas L. Sanders, Christopher L. Camp, Timothy Hewett, Michael J. Stuart, Daniel B.F. Saris, Aaron Krych

Research output: Contribution to journalArticle

Abstract

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P <.01) and nonoperative ACL management (19%, P <.01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment (P =.28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

Original languageEnglish (US)
Pages (from-to)1583-1590
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume47
Issue number7
DOIs
StatePublished - Jun 1 2019

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Tears
Osteoarthritis
Arthroplasty
Knee Replacement Arthroplasties
Anterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament Injuries
Tibial Meniscus
Therapeutics
Knee Osteoarthritis
Anterior Cruciate Ligament
Survival Analysis
Natural History
Sports
Orthopedics
Cohort Studies

Keywords

  • anterior cruciate ligament injury
  • long-term follow-up
  • meniscal tears
  • osteoarthritis
  • total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury : Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up. / Hagmeijer, Michella H.; Hevesi, Mario; Desai, Vishal S.; Sanders, Thomas L.; Camp, Christopher L.; Hewett, Timothy; Stuart, Michael J.; Saris, Daniel B.F.; Krych, Aaron.

In: American Journal of Sports Medicine, Vol. 47, No. 7, 01.06.2019, p. 1583-1590.

Research output: Contribution to journalArticle

Hagmeijer, Michella H. ; Hevesi, Mario ; Desai, Vishal S. ; Sanders, Thomas L. ; Camp, Christopher L. ; Hewett, Timothy ; Stuart, Michael J. ; Saris, Daniel B.F. ; Krych, Aaron. / Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury : Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up. In: American Journal of Sports Medicine. 2019 ; Vol. 47, No. 7. pp. 1583-1590.
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abstract = "Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16{\%}. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7{\%}) as compared with patients with delayed ACL reconstruction (33{\%}, P <.01) and nonoperative ACL management (19{\%}, P <.01). Of the 235 secondary meniscal tears identified (196 patients), 11.5{\%} underwent repair, 73{\%} partial meniscectomy, and 16{\%} were treated nonoperatively. Tears were most often medial in location (77{\%}) and complex in morphology (56{\%} of medial tears, 54{\%} of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0{\%}) underwent TKA, as opposed to 10.9{\%} undergoing meniscectomy and 6.1{\%} receiving nonoperative treatment (P =.28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.",
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T2 - Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

AU - Hagmeijer, Michella H.

AU - Hevesi, Mario

AU - Desai, Vishal S.

AU - Sanders, Thomas L.

AU - Camp, Christopher L.

AU - Hewett, Timothy

AU - Stuart, Michael J.

AU - Saris, Daniel B.F.

AU - Krych, Aaron

PY - 2019/6/1

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N2 - Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P <.01) and nonoperative ACL management (19%, P <.01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment (P =.28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

AB - Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P <.01) and nonoperative ACL management (19%, P <.01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment (P =.28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

KW - anterior cruciate ligament injury

KW - long-term follow-up

KW - meniscal tears

KW - osteoarthritis

KW - total knee arthroplasty

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