title: Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
abstract: BACKGROUND
  Identifying risk factors for inferior outcomes after anterior cruciate ligament reconstruction (ACLR) is important for prognosis and future treatment.
  
  
  OBJECTIVE
  Articular cartilage lesions and meniscus tears/treatment would predict International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level at 6 years after ACLR.
  
  
  METHODS
  Cohort study (prognosis); Level of evidence, 1.
  
  
  METHODS
  Between 2002 and 2004, a total of 1512 ACLR patients were prospectively enrolled and followed longitudinally, with the IKDC, KOOS, and Marx activity score completed at entry, 2 years, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC and KOOS scores and Marx activity level at 6 years.
  
  
  RESULTS
  A minimum follow-up on 86% (1307/1512) of the cohort was completed at 6 years. The cohort was 56% male and had a median age of 23 years at the time of enrollment, with 76% reporting a noncontact injury mechanism. Incidence of concomitant injury at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 25%; lateral femoral condyle [LFC] 20%; medial tibial plateau [MTP], 6%; lateral tibial plateau [LTP], 12%; patella, 20%; trochlear, 9%) and meniscus (medial, 38%; lateral, 46%). Both articular cartilage lesions and meniscus tears were significant predictors of 6-year outcomes on the IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. The IKDC demonstrated worse outcomes with the presence of a grade 3 or 4 chondral lesion on the MFC, MTP, and LFC. Likewise, the KOOS score was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity level was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse; conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher body mass index, lower education level, smoking, and anterior cruciate ligament revisions.
  
  
  CONCLUSIONS
  Both articular cartilage injury and meniscus tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years after ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient's Marx activity level score at 6 years.
authors.affiliation: Kurt P. Spindler, Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232-8774. kurt.spindler@vanderbilt.edu.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Cox
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
authors.forename: Emily K
authors.initials: EK
authors.lastname: Reinke
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Nwosu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Parker
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaeding
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.forename: Annunziata
authors.initials: A
authors.lastname: Amendola
authors.forename: Eric C
authors.initials: EC
authors.lastname: McCarty
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D015992:Body Mass Index; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000145:classification / Q000601:surgery; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D063868:Patient Outcome Assessment; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D000070600:Tibial Meniscus Injuries; D055815:Young Adult
keywords: ACL reconstruction; IKDC; KOOS; Marx activity rating scale; anterior cruciate ligament; articular cartilage, meniscus; outcomes