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 ( 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.