Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2-5 years follow-up

Abstract

Purpose: To investigate differences in patient-reported outcome after anterior cruciate ligament (ACL) reconstruction between patients with and without a concomitant full-thickness cartilage lesion.

Methods: 30 primary ACL-reconstructed patients with an isolated concomitant full-thickness cartilage lesion and 59 matched controls without cartilage lesions were identified in the Norwegian National Knee Ligament Registry and included in the present study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the outcome measure. At a median follow-up of 2.1 years (range, 2-5 years) after ACL reconstruction, 80 (90%) of the patients completed the KOOS.

Results: Preoperatively, there were no differences in KOOS between the study group and the control group. At follow-up, patients with full-thickness cartilage lesions reported significantly decreased scores compared to patients without cartilage lesions in the KOOS subscales pain (mean difference, 8.1; 95% confidence interval [CI], 0.8-15.3), activities in daily living (mean difference, 5.8; 95% CI, 0.3-11.2), sport/recreation (mean difference, 19.8; 95% CI, 5.3-34.3) and quality of life (mean difference, 17.2; 95% CI, 4.2-30.1). Patients with full-thickness cartilage lesions reported significantly less improvement from preoperative to follow-up than patients without cartilage lesions for the KOOS subscales pain (mean difference, 11.6; 95% CI, 3.2-19.9), sport/recreation (mean difference, 20.6; 95% CI, 8.1-33.1) and quality of life (mean difference, 16.3; 95% CI, 3.8-28.7).

Conclusions: ACL-injured patients with full-thickness cartilage lesions reported worse outcomes and less improvement after ACL reconstruction than those without cartilage lesions at 2-5 years follow-up.

Level of evidence: Prognostic; prospective cohort study, Level I.