Abstract
In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III–IV cartilage lesions, while Group 2 included 25 patients with grade I–II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (<.001) in both groups, with NS difference between the two groups (>0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (<0.001) compared to pre-operative values, but slight worsening was observed in Group 1 patients at the latest review. At the latest assessment, 10 knees (40%) in Group 1 and 3 knees (15%) in Group 2 demonstrated degenerative changes according to Fairbank grading. Concerning the WOMAC index score and sport activity level rating, Group 1 patients had significantly lower scores than Group 2 patients (P < 0.05). In patients with symptomatic ACL instability combined to grade III–IV cartilage lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes.
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References
Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br 66:666–671
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840
Bolano LE, Grana WA (1993) Isolated arthroscopic partial meniscectomy. Functional radiographic evaluation at five years. Am J Sports Med 21:432–437
Buckwalter JA, Mankin HJ (1997) Degeneration and osteoarthrosis, repair, regeneration, and transplantation. J Bone Joint Surg Am 79:612–632
Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86
Cerynik DL, Lewullis GE, Joves BC, Palmer MP, Tom JA (2009) Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc 17:1135–1139
Cox JS, Nye CE, Schaefer WW, Woodstein IJ (1975) The degenerative effects of partial and total resection of the medial meniscus in dogs’ knees. Clin Orthop Relat Res 109:178–183
Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726
Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Am 30B:664–670
Fetto JF, Marshall JL (1979) Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am 61:710–714
Gillquist J, Messner K (1999) Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 27:143–156
Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13:213–221
Gudas R, Stankevicius E, Monastyreckiene E, Pranys D, Kalesinskas RJ (2006) Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc 14:834–842
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234
Johnson DL, Urban WP Jr, Caborn DN, Vanarthos WJ, Carlson CS (1998) Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med 26:409–414
Joseph C, Pathak SS, Aravinda M, Rajan D (2008) Is ACL reconstruction only for athletes? a study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Int Orthop 32:57–61
Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A:455–464
Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37:33–41
Kowalchuk DA, Harner CD, Fu FH, Irrgang JJ (2009) Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 25:457–463
Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186
Kruger-Franke M, Siebert CH, Kugler A, Trouillier HH, Rosemeyer B (1999) Late results after arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 7:81–84
Melegati G, Tornese D, Bandi M, Volpi P, Schonhuber H, Denti M (2003) The role of the rehabilitation brace in restoring knee extension after anterior cruciate ligament reconstruction: a prospective controlled study. Knee Surg Sports Traumatol Arthrosc 11:322–326
Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56:1391–1396
Minas T, Nehrer S (1997) Current concepts in the treatment of articular cartilage defects. Orthopedics 20:525–538
Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37:2053–2063
Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920
Mithoefer K, Williams RJ 3rd, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418
Naranje S, Mittal R, Nag H, Sharma R (2008) Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee. Arthroscopy 24:1045–1051
Nishimori M, Deie M, Adachi N, Kanaya A, Nakamae A, Motoyama M, Ochi M (2008) Articular cartilage injury of the posterior lateral tibial plateau associated with acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 16:270–274
Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H (2007) Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15:1438–1444
Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto KP (1995) Osteoarthritis after arthroscopic partial meniscectomy. Am J Sports Med 23:240–244
Riyami M, Rolf C (2009) Evaluation of microfracture of traumatic chondral injuries to the knee in professional football and rugby players. J Orthop Surg Res 7:4–13
Robinson D, Nevo Z (2001) Articular cartilage chondrocytes are more advantageous for generating hyaline-like cartilage than mesenchymal cells isolated from microfracture repairs. Cell Tissue Bank 2:23–30
Schimmer RC, Brulhart KB, Duff C, Glinz W (1998) Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course. Arthroscopy 14:136–142
Sledge SL (2001) Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med 20:365–377
Spindler KP, Schils JP, Bergfeld JA, Andrish JT, Weiker GG, Anderson TE, Piraino DW, Richmond BJ, Medendorp SV (1993) Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy. Am J Sports Med 21:551–557
Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484
Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 15:170–176
Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391 Suppl:S362–S369
Swirtun LR, Renstrom P (2008) Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year follow-up. Scand J Med Sci Sports 18:318–324
Tandogan RN, Taser O, Kayaalp A, Taskiran E, Pinar H, Alparslan B, Alturfan A (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12:262–270
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93
van der Hart CP, van den Bekerom MP, Patt TW (2008) The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg 3:24
Vasara AI, Jurvelin JS, Peterson L, Kiviranta I (2005) Arthroscopic cartilage indentation and cartilage lesions of anterior cruciate ligament-deficient knees. Am J Sports Med 33:408–414
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Osti, L., Papalia, R., Del Buono, A. et al. Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries. Knee Surg Sports Traumatol Arthrosc 18, 1385–1390 (2010). https://doi.org/10.1007/s00167-009-1035-2
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DOI: https://doi.org/10.1007/s00167-009-1035-2