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Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine whether articular cartilage damage noted at the time of primary anterior cruciate ligament reconstruction (ACLR) affects the likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery or risk of recurrent ACL injury.

Methods

Five hundred and eight patients underwent primary ACLR and diagnostic arthroscopy. All identified cartilage lesions were graded using the Outerbridge system. All patients underwent isokinetic strength testing. The association between cartilage Outerbridge grade and a ≥ 90% Limb Symmetry Index (LSI) and recurrent ACL injury risk at mean 38.7 month follow-up (SD 31.8) was evaluated via multivariate regression analysis.

Results

Grade 2 or higher damage was present in 394 (77.5%) of patients, grade 3 or higher in 143 (28.1%) and grade 4 in 83 (16.4%) at time of ACLR. Ipsilateral ACLR graft rupture occurred in 31 (6.1%) of patients. Contralateral ACL injury occurred in 19 (3.7%). Patients with grade 2 or higher damage were significantly less likely to meet an LSI goal of ≥ 90% for fast (300°/s) isokinetic extension. There was no association with slow isokinetic extension. Cartilage lesion severity at or beyond grade 2 had a similar effect on isokinetic testing results regardless of compartment involvement or performance of microfracture. Patients with grade 2–4 cartilage damage were less likely to sustain a second ipsilateral ACL injury or a contralateral native ACL injury.

Conclusions

Cartilage damage seen at time of ACL reconstruction is common and associated with lower likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery. However, lower recurrent ACL injury rates are seen in patients with concurrent cartilage damage. These data may inform future clinical decisions regarding operative managment of recurrent ACL injuries.

Level of evidence

III.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Joshua S. Everhart, Alex C. DiBartola, Robert Pettit & David C. Flanigan

  2. Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, MI, USA

    Katherine Swank

  3. College of Medicine, The Ohio State University, Columbus, OH, USA

    Langston Hughes

  4. Department of Physical Therapy and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Caroline Lewis

  5. Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH, 43202, USA

    David C. Flanigan

Authors
  1. Joshua S. Everhart
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  2. Alex C. DiBartola
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  3. Katherine Swank
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  4. Robert Pettit
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  5. Langston Hughes
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  6. Caroline Lewis
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  7. David C. Flanigan
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Corresponding author

Correspondence to David C. Flanigan.

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The authors received no funding for this study and report no conflicts of interest.

Ethical approval

This project was approved by the Biomedical Institutional Research Board of The Ohio State University.

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Everhart, J.S., DiBartola, A.C., Swank, K. et al. Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury. Knee Surg Sports Traumatol Arthrosc 28, 576–583 (2020). https://doi.org/10.1007/s00167-019-05739-1

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  • DOI: https://doi.org/10.1007/s00167-019-05739-1

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