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. 2022 May;30(5):1836-1845.
doi: 10.1007/s00167-021-06757-8. Epub 2021 Oct 9.

Concomitant full-thickness cartilage lesions do not affect patient-reported outcomes at minimum 10-year follow-up after ACL reconstruction

Katherine Wang  1   2   3 , Cathrine N Eftang  4 , Svend Ulstein  5 , Asbjørn Årøen  5   6   7 , Rune B Jakobsen  5   6   8
Affiliations

Concomitant full-thickness cartilage lesions do not affect patient-reported outcomes at minimum 10-year follow-up after ACL reconstruction

Katherine Wang et al. Knee Surg Sports Traumatol Arthrosc. 2022 May.

Abstract

Purpose: To compare patients with a concomitant full-thickness cartilage lesion and anterior cruciate ligament (ACL) injury to patients with an isolated ACL injury at 10-15 years post ACL reconstruction.

Methods: This is a longitudinal follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the index study in 2007. The study group consisted of 30 patients that underwent ACL reconstruction and had a concomitant, isolated full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grade 3-4). Each study patient was matched with two control patients who underwent ACL reconstruction but had no cartilage lesions (ICRS grade 1-4) (n = 59). At a median follow-up of 10.2 years (range 9.9-15.6), 65 patients (74%) completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was the main outcome measure, resulting in 23 pairs after matching.

Results: At a follow-up of 10-15 years after ACL reconstruction, no significant differences in KOOS were found between patients with a concomitant full-thickness cartilage lesion and patients without cartilage lesions. There was also no significant difference between the two groups when comparing the change over time in KOOS scores from preoperative to follow-up. Both groups showed significant improvement in all KOOS subscales from preoperative to follow-up, except for in the Symptoms subscale for the control group. The greatest improvement was in the QoL subscale for the study group.

Conclusion: ACL-reconstructed patients with a full-thickness cartilage lesion did not report worse outcomes at 10-15 years after surgery compared with patients with an isolated ACL injury. Our findings support that there is no long-term negative effect of a concomitant cartilage lesion in an ACL-reconstructed knee. These findings should be considered when discussing treatment and informing about the expected long-term outcome after ACL reconstruction to patients with such combined injuries.

Level of evidence: II.

Keywords: Anterior cruciate ligament; Cartilage lesion; KOOS; Outcome; Reconstruction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow-chart illustrating patient inclusion and participation from index study by Hjermundrud et al. through subsequent follow-ups up to current study [19, 29, 40]. Anterior cruciate ligament (ACL); National Knee Ligament Registry (NKLR); International Cartilage Repair Society (ICRS); Knee injury and Osteoarthritis Outcome Score (KOOS)
Fig. 2
Fig. 2
Mean Knee Injury and Osteoarthritis Outcome Score (KOOS) of the study group (ACL injury with full-thickness cartilage lesion) and the control group (isolated ACL injury) at preoperative and a median of 10.2 years of follow-up after ACL reconstruction with standard deviation. Activities of daily living (ADL); Sports and recreation (Sport/rec); Quality of life (QoL); Anterior cruciate ligament (ACL)
Fig. 3
Fig. 3
Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL) subscale for the study group (ACL injury with full-thickness cartilage lesion) and the control group (isolated ACL injury) at preoperative and all follow-ups after ACL reconstruction with standard deviation. Preoperative data from Hjermundrud et al. [19], 2.1 years from Røtterud et al. [29], and 6.3 years from Ulstein et al. [40]
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