title: Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the incidence of failure of anterior cruciate ligament (ACL) reconstruction and to assess the prognostic factors for such an outcome.
  
  
  METHODS
  A prospective inception cohort of patients undergoing ACL reconstruction was analysed for failure (patient reported symptoms of rotational instability, a clinically positive pivot shift, MRI or arthroscopy showing ACL graft rupture). Risk factors evaluated included medial and lateral meniscal deficiency, medial and lateral meniscal repair, age, gender, BMI, graft size and time to surgery. Survival analysis was performed using the Kaplan-Meier method. Prognostic factors were assessed using the Cox proportional hazard model to investigate whether covariate risk factors influenced graft survival.
  
  
  RESULTS
  One hundred and twenty-three patients were available for final analysis at a follow-up of 2 years. Eighteen patients satisfied the criteria of failure (15.4 %). Risk factors for failure were medial meniscal deficiency (hazard ratio 4.5; 95 % CI 1.8-11.5; p = 0.002), or lateral meniscal deficiency (hazard ratio 3.5; 95 % CI 1.3-9.3; p = 0.01). At 2-year follow-up, ACL survival was 94.5 % (95 % CI 89-100) for patients with intact menisci and 69 % (95 % CI 56-86) for those with deficiency of the medial or lateral meniscus (log-rank test p = 0.017). Patients were 4.9 times more likely to fail if they had a deficient medial or lateral meniscus. Those patients who underwent meniscal repair did not demonstrate any increased risk of failure.
  
  
  CONCLUSIONS
  Medial and lateral meniscal tears are important prognostic factors that influence the survival of ACL reconstruction. Surgeons should endeavour to repair all meniscal tears associated with ACL reconstruction.
  
  
  METHODS
  II.
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK. curtis.robb@btopenworld.com.
authors.forename: Curtis
authors.initials: C
authors.lastname: Robb
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Kempshall
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Getgood
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
authors.forename: Hayley
authors.initials: H
authors.lastname: Standell
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sprowson
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Thompson
authors.affiliation: University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, West Midlands, CV2 2DX, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Spalding
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000209:etiology*; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000070600:Tibial Meniscus Injuries; D017211:Treatment Failure; D055815:Young Adult
keywords: Anterior cruciate ligament; Meniscus; Risk factors