J Knee Surg
DOI: 10.1055/s-0041-1736197
Original Article

Does Surgery for Cruciate Ligament and Meniscus Injury Increase the Risk of Comorbidities at 2 Years in the Military System?

1  Departmant of Orthopaedics, Duke University, Durham, North Carolina
2  Department of Population Health Sciences, Durham, North Carolina
3  Duke Clinical Research Institute, Durham, North Carolina
Andrew J. Sheean
4  Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas
Liang Zhou
5  Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
Kyong S. Min
5  Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
3  Duke Clinical Research Institute, Durham, North Carolina
6  Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas
› Author Affiliations


This study aims to determine whether surgery for cruciate ligament (anterior or posterior) or meniscus injury increased risks of subsequent comorbidities in beneficiaries of the Military Health System. The study was a retrospective case-control design in which individuals with cruciate or meniscus injuries were divided into two groups (surgery or none). Data were pulled 12 months prior and 24 months following each respective event and presence of comorbidities were compared between the two groups. Bivariate analyses and logistic regression were used to determine if surgery increased the odds of comorbidities. Participants included 1,686 with a cruciate ligament injury (30.1% treated surgically) and 13,146 with a meniscus injury (44.4% treated surgically). Bivariate comparisons of surgery versus nonsurgical treatment found multiple significant differences. After adjusting for covariates, a significant (p < 0.05) protective effect was seen only for meniscus surgery for concussion, insomnia, other mental health disorders, depression, and substance abuse. Surgery had no increased/decreased risk of comorbidities for cruciate ligament injuries. For meniscus injuries, surgery demonstrated a protective effect for six of the comorbidities we assessed. The treatment approach (surgery vs. nonsurgical) did not change the risk of comorbidities in those with a cruciate ligament injury. It is noteworthy that three of the six comorbidities involved mental health disorders. Although the study design does not allow for determination of causation, these findings should compel future prospective study designs that could confirm these findings.


The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, Tripler Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense or the U.S. Government.

Publication History

Received: 22 December 2020

Accepted: 18 August 2021

Publication Date:
05 October 2021 (online)

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA