Skip to main content
SpringerLink
Log in

Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

A debilitating complication following anterior cruciate ligament reconstruction is a secondary meniscus tear. Currently, the literature is mixed regarding the risk factors associated with the incidence of secondary meniscus tears. The aim of this study was to investigate risk factors associated with meniscus tears following an isolated primary anterior cruciate ligament reconstruction. ACL graft failure was hypothesized to be the strongest risk factor for secondary meniscal injury occurrence.

Methods

A retrospective cohort analysis was performed using the PearlDiver Database. Patients with a primary anterior cruciate ligament reconstruction were identified in the database. Patients with concomitant knee ligament injury or meniscus injury present at the time the index procedure were excluded. Patients were grouped to those who had a secondary meniscus tear within 2 years following anterior cruciate ligament reconstruction and those who did not. Univariate analysis and multivariable regression analysis was conducted to identify significant risk factors for a secondary meniscus tear.

Results

There were 25,622 patients meeting criteria for inclusion in this study. Within 2 years from the primary anterior cruciate ligament reconstruction, there were 1,781 patients (7.0%) that experienced a meniscus tear. Graft failure had the highest odds of having a postoperative meniscus tear within 2 years (OR: 4.1; CI 3.5–4.8; p < 0.002). Additional significant risk factors included tobacco use (OR: 2.0; CI 1.0–3.1; p < 0.001), increased Charlson Comorbidity Index (OR: 1.2; CI 1.1–1.4), male gender (OR: 1.1; CI 1.1–1.2; p < 0.001), obesity (OR: 1.1; CI 1.1–1.2; p < 0.001), delayed surgery (OR:1.1; CI 1.1–1.2; p < 0.002), and patients age 30 and older (OR: 1.0; CI 1.0–1.0; p < 0.001).

Conclusions

This study found that anterior cruciate ligament graft failure is the strongest predictor of post-operative meniscus tears. Other risk factors, including tobacco use, increased CCI, male gender, obesity, delayed surgery, and age 30 and older, were established, with several being modifiable. Therefore, targeted preoperative optimization of modifiable risk factors and postoperative protocols may reduce the risk of secondary meniscus tears.

Level of evidence

Level III, prognostic trial.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Availability of data and materials

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

CCI:

Charlson comorbidity index

CI:

Confidence interval

CPT:

Current procedure terminology

ICD:

International classification of diseases

IRB:

Institutional Review Board

OR:

Odds ratio

References

  1. Beaufils P, Becker R, Verdonk R, Aagaard H, Karlsson J (2014) Focusing on results after meniscus surgery. Knee Surg Sports Traumatol Arthrosc 23(1):3–7

    Article  Google Scholar 

  2. Bokshan SL, DeFroda SF, Owens BD (2017) Risk factors for hospital admission after anterior cruciate ligament reconstruction. Arthroscopy 33(7):1405–1411

    Article  PubMed  Google Scholar 

  3. Chan CX, Silas C, Ifran NN, Mok YR, Krishna L (2020) Risk factors for new meniscal tears following anterior cruciate ligament reconstruction. J Knee Surg 35(5):529–533

    PubMed  Google Scholar 

  4. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  5. Chen KH, Chiang ER, Wang HY, Ma HL (2018) Correlation of meniscal tear with timing of anterior cruciate ligament reconstruction in patients without initially concurrent meniscal tear. J Knee Surg 32(11):1128–1132

    PubMed  Google Scholar 

  6. Cipolla M, Scala A, Gianni E, Puddu G (1995) 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 3(3):130–134

    Article  CAS  PubMed  Google Scholar 

  7. Cvetanovich GL, Chalmers PN, Verma NN, Cole BJ, Bach BR (2016) Risk factors for short-term complications of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 44(3):618–624

    Article  PubMed  Google Scholar 

  8. Ding DY, Zhang AL, Allen CR, Anderson AF, Cooper DE, Deberardino TM et al (2017) Subsequent surgery after revision anterior cruciate ligament reconstruction: rates and risk factors from a multicenter cohort. Am J Sports Med 45(9):2068

    Article  PubMed  PubMed Central  Google Scholar 

  9. Everhart JS, Kirven JC, Abouljoud MM, DiBartola AC, Kaeding CC, Flanigan DC (2019) Effect of delayed primary anterior cruciate ligament reconstruction on medial compartment cartilage and meniscal health. Am J Sports Med 47(8):1816–1824

    Article  PubMed  Google Scholar 

  10. Fox AJS, Bedi A, Rodeo SA (2012) The basic science of human knee menisci: structure, composition, and function. Sports Health 4(4):340

    Article  PubMed  PubMed Central  Google Scholar 

  11. Glassou EN, Pedersen AB, Hansen TB (2017) Is decreasing mortality in total hip and knee arthroplasty patients dependent on patients’ comorbidity? Acta Orthop 88(3):288–293

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gundtoft PH, Jørstad M, Erichsen JL, Schmal H, Viberg B (2021) The ability of comorbidity indices to predict mortality in an orthopedic setting: a systematic review. Syst Rev 10(1):234

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hagmeijer MH, Hevesi M, Desai VS, Sanders TL, Camp CL, Hewett TE et al (2019) Secondary meniscal tears in patients with anterior cruciate ligament injury: relationship among operative management, osteoarthritis, and arthroplasty at 18-year mean follow-up. Am J Sports Med 47(7):1583–1590

    Article  PubMed  Google Scholar 

  14. Hughes JD, Lawton CD, Nawabi DH, Pearle AD, Musahl V (2020) Anterior cruciate ligament repair: the current status. J Bone Jt Surg Am 102(21):1900–1915

    Article  Google Scholar 

  15. Jurgensmeier K, Till SE, Lu Y, Arguello AM, Stuart MJ, Saris DBF et al (2023) Risk factors for secondary meniscus tears can be accurately predicted through machine learning, creating a resource for patient education and intervention. Knee Surg Sports Traumatol Arthrosc 31(2):518–529

    Article  PubMed  Google Scholar 

  16. Korpershoek JV, de Windt TS, Vonk LA, Krych AJ, Saris DBF (2020) Does anterior cruciate ligament reconstruction protect the meniscus and its repair? A systematic review. Orthop J Sports Med 8(7):2325967120933895

    PubMed  PubMed Central  Google Scholar 

  17. Laskow T, Zhu J, Buta B, Oni J, Sieber F, Bandeen-Roche K et al (2022) Risk factors for nonresilient outcomes in older adults after total knee replacement. J Gerontol A Biol Sci Med Sci 77(9):1915–1922

    Article  PubMed  Google Scholar 

  18. Levy IM, Torzilli PA, Gould JD, Warren RF (1989) The effect of lateral menisceectomy on motion of the knee. J Bone Jt Surg Am 71(3):401–406

    Article  CAS  Google Scholar 

  19. Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior–posterior motion of the knee. J Bone Jt Surg Am 64(6):883–888

    Article  CAS  Google Scholar 

  20. Lu Y, Jurgensmeier K, Till SE, Reinholz A, Saris DBF, Camp CL, Krych AJ (2022) Early ACLR and risk and timing of secondary meniscal injury compared with delayed ACLR or nonoperative treatment: a time-to-event analysis using machine learning. Am J Sports Med 50(13):3544–3556

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mehl J, Otto A, Baldino JB, Achtnich A, Akoto R, Imhoff AB et al (2019) The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg 139(6):819–841

    Article  PubMed  Google Scholar 

  22. Mortazavi SMJ, Moharrami A, Tamhri SS, Okati A, Shamabadi A (2021) Time from injury is the key predictor of meniscal injury in ACL-deficient knees. J Knee Surg 35(10):1091–1096

    PubMed  Google Scholar 

  23. O’Donnell JM, Ekunseitan E, Swarup I (2023) Factors associated with subsequent surgery after septic arthritis of the knee in children. World J Clin Pediatr 12(2):38–44

    Article  PubMed  PubMed Central  Google Scholar 

  24. Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H (2007) Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15(12):1438–1444

    Article  PubMed  Google Scholar 

  25. Rochcongar G, Cucurulo T, Ameline T, Potel JF, Dalmay F, Pujol N et al (2015) Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 101(8):S323–S326

    Article  CAS  PubMed  Google Scholar 

  26. Sanders TL, Maradit Kremers H, Bryan AJ, Fruth KM, Larson DR, Pareek A et al (2016) Is anterior cruciate ligament reconstruction effective in preventing secondary meniscal tears and osteoarthritis? Am J Sports Med 44(7):1699–1707

    Article  PubMed  Google Scholar 

  27. Snoeker BAM, Roemer FW, Turkiewicz A, Lohmander S, Frobell RB, Englund M (2020) Does early anterior cruciate ligament reconstruction prevent development of meniscal damage? Results from a secondary analysis of a randomised controlled trial. Br J Sports Med 54(10):612–617

    PubMed  Google Scholar 

  28. Vaishya R, Agarwal AK, Ingole S, Vijay V (2015) Current trends in anterior cruciate ligament reconstruction: a review. Cureus 7(11):e378

    PubMed  PubMed Central  Google Scholar 

  29. Wyatt RWB, Inacio MCS, Bellevue KD, Schepps AL, Maletis GB (2017) Isolated ACL versus multiple knee ligament injury: associations with patient characteristics, cartilage status, and meniscal tears identified during ACL reconstruction. Phys Sportsmed 45(3):323–328

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. The George Washington University School of Medicine and Health Sciences, 2300 I (Eye) St NW, Washington, DC, 20052, USA

    David Sproul, Amil Agarwal, Alisa Malyavko & Abhay Mathur

  2. Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, 10700 Charter Drive, Suite 205, Columbia, MD, 21044, USA

    R. Timothy Kreulen, Savyasachi C. Thakkar & Matthew J. Best

Authors
  1. David Sproul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amil Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alisa Malyavko
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abhay Mathur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Timothy Kreulen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Savyasachi C. Thakkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Matthew J. Best
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DS contributed to the conception, design, and interpretation of data; drafted the introduction, discussion, and conclusion of the manuscript; revised the manuscript; and gave final approval of the version to be published. AA contributed to the acquisition of data and revised the manuscript. AM drafted the methods and results section of the manuscript. AM revised the manuscript critically for important intellectual content. RTK revised the manuscript critically for important intellectual content. SCT revised the manuscript critically for important intellectual content and gave final approval of the version to be published. MJB revised the manuscript critically for important intellectual content and gave final approval of the version to be published.

Corresponding author

Correspondence to David Sproul.

Ethics declarations

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

IRB approved; study utilized a database, where information is recorded in such a manner that subjects cannot be identified, either directly or indirectly through identifiers linked to subjects.

Informed consent

N/A; retrospective study utilized a database, where information is recorded in such a manner that subjects cannot be identified, either directly or indirectly through identifiers linked to subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sproul, D., Agarwal, A., Malyavko, A. et al. Graft failure within 2 years of isolated anterior cruciate ligament reconstruction is associated with increased risk of secondary meniscus tears. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07653-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00167-023-07653-z

Keywords

search

Navigation