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



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


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.


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).


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.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB (2009) Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil 17:1434–1439

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Bent NP, Wright CC, Rushton AB, Batt ME (2009) Selecting outcome measures in sports medicine: a guide for practitioners using the example of anterior cruciate ligament rehabilitation. Br J Sports Med 43:1006–1012

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897

    PubMed  Article  Google Scholar 

  4. 4.

    Brittberg M, Peterson L (1998) Introduction of an articular cartilage classification. ICRS Newsl 1:5–8

    Google Scholar 

  5. 5.

    Brophy RH, Zeltser D, Wright RW, Flanigan D (2010) Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy 26:112–120

    PubMed  Article  Google Scholar 

  6. 6.

    Cohen J (1988) Statistical power analaysis for the behavioral sciences, 2nd edn. Hillsdale, NJ, Lawrence Erlbaum Associates, p 25

    Google Scholar 

  7. 7.

    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

    PubMed  Google Scholar 

  8. 8.

    Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008) Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 36:308–315

    PubMed  Article  Google Scholar 

  9. 9.

    Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries 2004–2007: baseline epidemiology. Acta Orthop 80:563–567

    PubMed  Article  Google Scholar 

  10. 10.

    Hjermundrud V, Bjune TK, Risberg MA, Engebretsen L, Aroen A (2010) Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 18:298–303

    PubMed  Article  Google Scholar 

  11. 11.

    Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38:455–463

    PubMed  Article  Google Scholar 

  12. 12.

    Kirkwood BR, Sterne JAC (2003) Essential medical statistics, 2nd edn. Oxford, Blackwell Publishing, p 368

    Google Scholar 

  13. 13.

    Oiestad BE, Holm I, Gunderson R, Myklebust G, Risberg MA (2010) Quadriceps muscle weakness after anterior cruciate ligament reconstruction: a risk factor for knee osteoarthritis? Arthritis Care Res (Hoboken) 62:1706–1714

    Article  Google Scholar 

  14. 14.

    Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38

    PubMed  Article  Google Scholar 

  15. 15.

    Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    PubMed  Article  Google Scholar 

  16. 16.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    PubMed  CAS  Google Scholar 

  17. 17.

    Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2011) Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees: a nationwide cohort study from Sweden and Norway of 15,783 patients. Am J Sports Med 39:1387–1394

    PubMed  Article  Google Scholar 

  18. 18.

    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-A(Suppl 2):8–16

    PubMed  Google Scholar 

  19. 19.

    Spindler KP, Warren TA, Callison JC Jr, Secic M, Fleisch SB, Wright RW (2005) Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 87:1673–1679

    PubMed  Article  Google Scholar 

  20. 20.

    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  21. 21.

    Widuchowski W, Widuchowski J, Koczy B, Szyluk K (2009) Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: results at 10- and 15-year follow-up. Am J Sports Med 37:688–692

    PubMed  Article  Google Scholar 

Download references


We would like to thank The National Knee Ligament Registry in Norway for providing the data for the current study; PT Vegar Hjermundrud, Akershus University Hospital for his work on the index study; the Norwegian Sports Medicine Association Research Grant and Eckboe’s Research Grant for funding the index study; MD, PhD Einar A. Sivertsen at Department of Orthopedic Surgery, Akershus University Hospital for statistical advice and his review of the manuscript; Oslo Sports Trauma Research Center for advisory support; and Akershus University Hospital and South-Eastern Norway Regional Health Authority for economic support while conducting the current study.

Conflict of interest

The authors declare no conflicts of interest.

Author information



Corresponding author

Correspondence to Jan Harald Røtterud.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Røtterud, J.H., Risberg, M.A., Engebretsen, L. et al. Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up. Knee Surg Sports Traumatol Arthrosc 20, 1533–1539 (2012).

Download citation


  • Anterior cruciate ligament
  • Cartilage lesion
  • Outcome
  • KOOS