AJSM - 2026-05-11 - Journal Article
Concomitant Intra-articular Injuries in 37,423 Primary and Revision ACL Reconstructions: A Systematic Review and Meta-analysis of Comparative Studies.
Vega TF, Thamrongskulsiri N, Brinkman JC, Pérez Lloveras GO, Casanova F, Cerezal Á, San Roman AV, Borace AF, Hazime D, Moews LD, Chahla J
Topics
Key Takeaway
Revision ACLR carries 1.6-fold higher odds of meniscal injury (OR 1.64) and 3.5-fold higher odds of chondral lesions (OR 3.53) compared to primary ACLR across 37,423 cases.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This PRISMA-compliant systematic review and meta-analysis compared intraoperative meniscal and chondral findings between primary and revision ACLRs across 19 comparative studies. Revision ACLR was associated with OR 1.64 for meniscal injury and OR 3.53 for chondral lesions, with the trochlea (OR 3.21), medial tibial plateau (OR 3.12), and medial femoral condyle (OR 2.99) most affected. High-grade chondral lesions (Outerbridge/ICRS grades 3–4) were consistently more prevalent at revision, with cartilage progression documented in up to 26% of intrapatient comparisons.
Key Limitation
All 19 included studies are retrospective comparative cohorts (Level IV), meaning chondral grading consistency, timing of index injury, and documentation of prior meniscectomy vary across centers, limiting the reliability of pooled risk factor analysis.
Original Abstract
BACKGROUND
Intra-articular lesions of menisci and cartilage are common in anterior cruciate ligament reconstruction (ACLR) and may differ between primary and revision procedures. Clarifying their prevalence, morphology, and risk factors is important for prognosis and surgical planning.
PURPOSE
To perform a systematic review and meta-analysis comparing the prevalence and risk factors for intra-articular injuries in primary versus revision ACLR.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, MEDLINE, and Embase databases were searched, supplemented by citation review and author contact. Comparative studies reporting intraoperative meniscal and/or chondral findings in both primary and revision ACLRs were included. Pooled odds ratios with 95% confidence intervals were calculated using random- or fixed-effects models.
RESULTS
Nineteen studies consisting of 37,423 ACLRs were included. Revision ACLR was associated with higher odds of meniscal injury (OR, 1.64; 95% CI, 1.12-2.41). Meniscal treatment did not differ significantly between groups. Chondral lesions were >3-fold more prevalent in revisions (OR, 3.53; 95% CI, 2.71-4.60), especially at the trochlea (OR, 3.21; 95% CI, 2.59-3.97; I 2 = 33%), medial tibial plateau (OR, 3.12; 95% CI, 2.61-3.73; I 2 = 0%), and medial femoral condyle (OR, 2.99; 95% CI, 2.30-3.89; I 2 = 61%). High-grade lesions (Outerbridge/International Cartilage Regeneration & Joint Preservation Society grades 3 and 4) were consistently more common in revisions, with progression observed in up to 26% of intrapatient comparisons. Risk factors reported for intra-articular injuries on revision ACLR included older age, male sex, tunnel malposition, malalignment, increased tibial slope, longer time to revision, and prior meniscectomy.
CONCLUSION
In this review of >37,000 ACLRs, revision status was associated with 1.6-fold higher odds of meniscal tears and 3.5-fold higher odds of chondral lesions compared with primary reconstruction. Chondral injury at revision was more prevalent across all compartments and consistently more severe, with the greatest risk observed in the trochlea and medial compartment. These findings demonstrate a substantially greater intra-articular disease burden at the time of revision surgery.