Abstract
There is debate in the literature regarding the impact of full-thickness cartilage lesion on knee function in patients with ACL injury. The hypothesis of the current study is that a full-thickness cartilage lesion at the time of ACL reconstruction does not influence knee function as measured by the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with ACL injury. Of the 4,849 primary ACL surgery cases in the Norwegian National Knee Ligament Registry as of 12 December 2007, 30 patients met the following inclusion criteria: a full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grades 3 and 4), age less than 40 years, no associated pathology or meniscus injury, and less than 1 year between knee injury and ACL reconstruction. Each of the 30 patients in this study group was matched with two control participants without cartilage lesions. Preoperatively, the patients completed the KOOS, and the surgeon recorded the location and size of the cartilage lesion and graded the cartilage injury according to ICRS standards. There were no significant differences between the case and control groups for any of the five subscales of the KOOS. A cartilage lesion was located in the medial compartment in 67% of the cases, in the lateral compartment in 20% of the cases, and in the patellofemoral joint in 13% of the cases. In conclusion, the combination of a full-thickness cartilage lesion and an ACL rupture did not result in inferior knee function at the time of the ACL reconstruction as measured by the KOOS.
Similar content being viewed by others
References
Alfredson H, Thorsen K, Lorentzon R (1999) Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation. Knee Surg Sports Traumatol Arthrosc 7:69–74
Andriacchi TP, Briant PL, Bevill SL, Koo S (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44
Aroen A, Loken S, Heir S et al (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32:211–215
Asano H, Muneta T, Ikeda H et al (2004) Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients. Arthroscopy 20:474–481
Bekkers JE, de Windt TS, Raijmakers WJ et al (2009) Validation of the knee injury and osteoarthritis outcome score (KOOS) for the treatment of focal cartilage lesions. Osteoarthritis Cartilage, 7 May [Epub ahead of print]
Browne JE, Branch TP (2000) Surgical alternatives for treatment of articular cartilage lesions. J Am Acad Orthop Surg 8:180–189
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
Curl WW, Krome J, Gordon ES et al (1997) Cartilage injuries: a review of 31, 516 knee arthroscopies. Arthroscopy 13:456–460
Drogset JO, Grontvedt T (2002) Anterior cruciate ligament reconstruction with and without a ligament augmentation device: results at 8-year follow-up. Am J Sports Med 30:851–856
Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 37:955–961
Granan LP, Bahr R, Steindal K et al (2008) Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 36:308–315
Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36:1695–1704
Hanypsiak BT, Spindler KP, Rothrock CR et al (2008) Twelve-year follow-up on anterior cruciate ligament reconstruction: long-term outcomes of prospectively studied osseous and articular injuries. Am J Sports Med 36:671–677
Klinger HM, Baums MH, Otte S, Steckel H (2003) Anterior cruciate reconstruction combined with autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 11:366–371
Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152
Nakamae A, Engebretsen L, Bahr R et al (2006) Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc 14:1252–1258
Roos EM, Roos HP, Lohmander LS et al (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96
Roos EM, Davis A, Beynnon BD (2009) Letter to the editor. Am J Sports Med 37:1042–1043
Shelbourne KD, Jari S, Gray T (2003) Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am 85:8–16
Spindler KP, Warren TA, Callison JC Jr et al (2005) Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 87:1673–1679
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
von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273
Acknowledgments
We would like to thank the National Knee Ligament Registry in Norway, especially Kjersti Steindal, for providing the data for the current study. We also thank the Oslo Sports Trauma Research Center and Eckboe’s grant for support while conducting the study.
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hjermundrud, V., Bjune, T.K., Risberg, M.A. et al. Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 18, 298–303 (2010). https://doi.org/10.1007/s00167-009-0894-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-009-0894-x