Does early anterior cruciate ligament reconstruction prevent further meniscal damage? Secondary analysis of a randomized controlled trial
ESSKA Academy. Snoeker B. Nov 8, 2019; 284426; epESMA-12 Topic: Sports Related Injuries
Dr. Barbara Snoeker
Dr. Barbara Snoeker
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Does early anterior cruciate ligament reconstruction prevent further meniscal damage? Secondary analysis of a randomized controlled trial

ePoster - epESMA-12

Topic: Sports Trauma

Snoeker B.1, Roemer F.2,3, Turkiewicz A.1, Lohmander S.1, Frobell R.1, Englund M.1,4
1Lund University, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden, 2University of Erlangen, Department of Radiology, Erlangen, Germany, 3Boston University School of Medicine, Department of Radiology, Boston, United States, 4Boston University School of Medicine, Clinical Epidemiology Research and Training Unit, Boston, United States

Introduction: It has been suggested that recurrent instability episodes in a non-reconstructed anterior cruciate ligament (ACL) injured knee increase the risk for an incident meniscal tear. However, the evidence comes from observational studies with high risk of selection bias.
Objectives: To provide low risk-of-bias evidence on the effects of early ACL reconstruction compared to optional delayed ACL reconstruction in the prevention of further meniscal damage.
Aims: To determine development of meniscal damage over 5 years after ACL injury using data from the only randomized controlled trial in the field, comparing rehabilitation plus early ACL reconstruction (“early ACLR”) vs rehabilitation with optional delayed ACL reconstruction (“optional delayed ACLR”) .
Methods: We used longitudinal knee MRIs including 121 young adults (ISRCTN 84752559; ethics approval LU 535-01). One musculoskeletal radiologist read baseline and 5-year follow-up images using the Anterior Cruciate Ligament Osteoarthritis Score (ACLOAS). We defined development of meniscal damage both dichotomously and as sum score representing severity (based on the sum of reclassified ACLOAS meniscus grades). In the full analysis set, we analyzed development of meniscal damage (yes/no) with logistic regression, and severity with zero-inflated Poisson regression. Analyses were performed both on knee and on compartment level, and adjusted for age, sex, and baseline meniscal damage.
Results: In early ACLR, 60 of 62 participants remained (2 missing baseline MRIs). In optional delayed ACLR, 55 of 59 subjects had longitudinal MRIs. After 5 years we found a risk difference for development of meniscal damage on knee level of 13% (95% confidence interval [95%CI]=-4%-30%) in optional delayed ACLR vs early ACLR. For medial and lateral meniscal damage, respectively, the risk differences were 20% (95%CI=5%-36%) and 0% (95%CI=-14%-12%). The mean severity score was 1.5 higher (more severe damage) on knee level in optional delayed ACLR vs early ACLR (95%CI=1.1-1.9) among those with meniscal damage at 5 years. For medial and lateral meniscal damage, respectively, the corresponding ratios were 1.7 (95%CI=1.2-2.5) and 1.0 (95%CI=0.8-1.4).
Conclusion: A strategy of early ACLR may reduce development of medial meniscal damage following ACL injury. For the lateral meniscus, ACLR seems neither to be protective nor to increase the risk of damage.
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