No negative effect on patient-reported outcome of concomitant cartilage lesions 5–9 years after ACL reconstruction
- 524 Downloads
To compare patient-reported outcome 5–9 years after anterior cruciate ligament (ACL) reconstruction in patients with and without a concomitant full-thickness [International Cartilage Repair Society (ICRS) grade 3–4] cartilage lesion.
This is a prospective follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the current study in 2007, consisting of 30 primary ACL-reconstructed patients with a concomitant, isolated full-thickness cartilage lesion (ICRS grade 3 and 4) and 59 matched controls without cartilage lesions (ICRS grade 1–4). At a median follow-up of 6.3 years (range 4.9–9.1) after ACL reconstruction, 74 (84 %) patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was used as the main outcome measure. Secondary outcomes included radiographic evaluation according to the Kellgren–Lawrence criteria of knee osteoarthritis (OA).
At follow-up, 5–9 years after ACL reconstruction, no statistically significant differences in KOOS were detected between patients with a concomitant full-thickness cartilage lesion and patients without concomitant cartilage lesions. Radiographic knee OA of the affected knee, defined as Kellgren and Lawrence ≥2, was significantly more frequent in subjects without a concomitant cartilage lesion (p = 0.016).
ACL reconstruction performed in patients with an isolated concomitant full-thickness cartilage lesion restored patient-reported knee function to the same level as ACL reconstruction performed in patients without concomitant cartilage lesions, 5–9 years after surgery. This should be considered in the preoperative information given to patients with such combined injuries, in terms of the expected outcome after ACL reconstruction and in the counselling and decision-making on the subject of surgical treatment of the concomitant cartilage lesion.
Level of evidence
Prognostic; prospective cohort study, Level I.
KeywordsAnterior cruciate ligament Reconstruction Cartilage lesion Outcome KOOS
We would like to thank the National Knee Ligament Registry in Norway for providing the data for the current study. We also thank the Oslo Sports Trauma Research Center for support while conducting the study. Grant research support from Akershus University Hospital is appreciated for the current study.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
- 3.Brittberg M, Peterson L (1998) Introduction of an articular cartilage classification. ICRS Newsl 1:5–8Google Scholar
- 4.Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 63(Suppl 11):S208–S228CrossRefGoogle Scholar
- 5.Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, Wright RW, Kaeding CC, Marx RG, Amendola A, McCarty EC, Spindler KP (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42(5):1058–1067CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Filardo G, de Caro F, Andriolo L, Kon E, Zaffagnini S, Marcacci M (2016) Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review. Knee Surg Sports Traumatol Arthrosc [Epub ahead of print] Google Scholar
- 14.Janssen RP, du Mee AW, van Valkenburg J, Sala HA, Tseng CM (2013) Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol Arthrosc 21(9):1977–1988CrossRefPubMedGoogle Scholar
- 17.Kirkwood BRSJ (2003) Essential medical statistics, 2nd edn. Blackwell Publishing, Oxford, p 368Google Scholar
- 22.Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2013) Effect of meniscal and focal cartilage lesions on patient-reported outcome after anterior cruciate ligament reconstruction: a nationwide cohort study from Norway and Sweden of 8476 patients with 2-year follow-up. Am J Sports Med 41(3):535–543CrossRefPubMedGoogle Scholar
- 24.Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen 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(7):1387–1394CrossRefPubMedGoogle Scholar
- 27.Spindler KP, Huston LJ, Wright RW, Kaeding CC, Marx RG, Amendola A, Parker RD, Andrish JT, Reinke EK, Harrell FE Jr, Group M, Dunn WR (2011) The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 39(2):348–359CrossRefPubMedGoogle Scholar
- 28.Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar