Even minor concomitant meniscus injuries are associated with posttraumatic osteoarthritis 15 years after anterior cruciate ligament reconstruction

Purpose The aim was to evaluate the associations between baseline variables on the development of a symptomatic knee and imaging evidence of posttraumatic osteoarthritis (PTOA) 15 years after anterior cruciate ligament (ACL) surgery. Methods Data from 42 subjects enroled in the Tension Trial (NCT00434837) were evaluated at 15‐year follow‐up. Patient sex, meniscus injury, preoperative patient‐reported outcomes (Knee Osteoarthritis Outcome Score [KOOS] function sports and recreation subscore [KOOS‐sport], Short Form [SF]‐36 mental health score), initial graft tension, and subsequent ACL surgery were evaluated to identify patients with a symptomatic knee using KOOS criteria (KOOS‐Quality of life ≤87.5 and with at least two other subscores meeting the following thresholds (i.e., KOOS‐Pain ≤86.1, KOOS‐Symptoms ≤85.7, KOOS‐Activities of daily living ≤86.8 and KOOS‐Sport ≤85.0) and imaging evidence of PTOA (Osteoarthritis Research Society International [OARSI] radiographic score and Whole‐Organ Magnetic Resonance Imaging Score [WORMS]) 15 years post‐surgery using stepwise regression. Results The presence of a baseline meniscus tear was associated with a seven‐fold increase ( p = 0.03) in odds for a symptomatic knee at 15 years. A higher preoperative KOOS‐sport was associated with a decreased occurrence of a symptomatic knee ( p = 0.06). A higher KOOS‐sport and the presence of a meniscus tear at baseline were associated with a greater OARSI difference score ( p = 0.03 and p = 0.05, respectively) 15 years after ACL reconstruction. The presence of the baseline meniscus tear was associated with a higher WORMS ( p = 0.07) 15 years after ACL reconstruction. All other variables were not significant predictors, though loss to follow‐up was over 50%. Conclusion The presence of a minor meniscus injury was associated with a higher occurrence of a symptomatic knee and imaging evidence of posttraumatic osteoarthritis 15 years after ACL reconstruction. Furthermore, a higher preoperative KOOS‐sport was associated with decreased occurrence of a symptomatic knee. Further studies are required to elucidate the associations of KOOS‐sport with imaging PTOA. Level of Evidence Level IV.