Effect of Osteochondral and Meniscal Injury on Patient Reported Outcomes at Return to Sport Following Anterior Cruciate Ligament Reconstruction in Young Athletes

OBJECTIVES: Concomitant pathology at the time of ACL injury has the potential to affect outcomes after ACL reconstruction (ACLR). The effect of concomitant meniscal and osteochondral injury on patient reported outcomes (PRO) has been investigated inclusive of a wide range of ages, but has yet to be specifically reported in young, active patients at the time of return to sport (RTS). The purpose of this study was to determine if the presence of concomitant meniscal (MEN) or osteochondral (OC) pathology affected PRO at the time of RTS following ACLR in young athletes. The hypothesis tested was that concomitant pathology at the time of injury would result in poorer PRO at the time of RTS. METHODS: One hundred and one (67 female) young (range 10-25 years old), active level I/II athletes were included in this study. All subjects underwent ACLR, rehabilitation, and were released to RTS. Meniscal pathology was confirmed intra-operatively and OC injury was confirmed with pre-operative MRI. All participants completed the International Knee Documentation Committee (IKDC) questionnaire and the KOOS (Knee Injury and Osteoarthritis Outcome Score) scale, at the time of RTS. One-way ANOVA was used to assess differences in PRO between patients with and without concomitant injury. Chi-square analyses were used to determine if patients with concomitant pathology were more likely to present with PRO less than age-matched normative data on the IKDC. RESULTS: Concomitant OC injury was present in 59/101 patients, MEN pathology was present in 52/101 patients and both OC/MEN injury was present in 33/101 patients at the time of ACLR. One-way ANOVA determined that patients with OC injury had lower IKDC (p=0.001), KOOS pain (p=0.0-14), and KOOS Sport (p=0.002) scores than patients with no OC pathology. Patients with MEN pathology presented with lower KOOS Sport scores (p=0.03). Patients with combined OC/MEN injury had lower IKDC (p=0.009), KOOS ADL (p=0.024) and KOOS Sport (p<0.001) scores. Chi square analysis demonstrated that patients with an OC injury were nearly 3 times (OR=2.9; 95% CI, 1.1-7.8) more likely to present with an IKDC score below previously reported age-matched (18-24 years/old) general population norms (female=85.7, male=89.1) and also 3 times (OR=3.2; 95% CI, 1.4-7.6) more likely to score below age-matched norms of patients with no prior history of knee injury (female=93.4, male=95.5). Patients with combined OC/MEN pathology were nearly 4 times (OR=3.9; 95%CI, 1.3-11.4) more likely to present with an IKDC score below healthy age-matched norms. MEN pathology did not increase the likelihood of presenting with IKDC scores lower than population. CONCLUSION: The presence of OC and combined OC/MEN injury in young, active patients at time of ACLR may predict poorer patient reported function at the time of return to sport. The presence of OC injury should be addressed more closely in the post-operative management after ACLR.