Higher rates of meniscal and chondral lesions in second compared with first revision anterior cruciate ligament reconstructions.

Abstract

The aim of this study was to describe the rate of meniscal and chondral lesions in patients undergoing their first revision anterior cruciate ligament (ACL) reconstruction compared with those undergoing a second revision reconstruction. This was a retrospective single-centre study, involving patients who underwent at least one revision ACL reconstruction between January 2012 and January 2022. Inclusion criteria were all patients aged between 16 and 60 years who underwent revision ACL reconstruction. Exclusion criteria were those with a multiligament knee injury, those who underwent a concomitant osteotomy, and those who had undergone ≥ three previous reconstructions. A total of 257 patients met the inclusion criteria. Of these, for 204 patients it was their first revision (R1), and for 51 it was their second revision (R2). Two patients who underwent a third revision were excluded. Medial meniscal tears were significantly more prevalent in the R2 group than in the R1 group - 40 (78.4%) compared with 106 (51.9%) (p < 0.001). There was no difference in the rates of the type of meniscal treatment in the medial and lateral compartments between the R1 and R2 groups. Chondral lesions were significantly more prevalent in the R2 group: 33 (64.7%) compared with 97 (47.6%) (p = 0.045). Medial and lateral compartment chondral lesions were significantly more prevalent in the R2 group (56.9% and 39.2%, respectively) compared with the R1 group (36.3% and 13.5%) (p = 0.012 and p = 0.001). The rates of meniscal tears and chondral lesions were significantly higher in patients undergoing their second ACL revision reconstruction compared with those undergoing their first revision reconstruction, and were present in between 50% and 85% of patients. Medial and lateral compartment chondral lesions were significantly more prevalent in those undergoing a second ACL revision reconstruction group compared with those undergoing their first ACL revision reconstruction, with a nearly threefold higher rate in the lateral compartment.