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No negative effects reported on cartilage lesions 5–9 years after ACL reconstruction


The results from a recently published study on the mid- to long-term outcome after ACL-reconstruction questions the understanding that patients with a concomitant cartilage lesion do not recover to the same extent as patients with an isolated ACL-tear.

These are the main findings of Dr Ulsteins study, which is part of his PhD-project, performed at Akershus University hospital. Ulstein (picture) and the co-authors are members of the Oslo Sports Trauma Research Center.

Comparable knee function as per patient reports

At a median follow-up of 6.3 years after ACL-reconstruction, the restoration of knee function was similar for patients with a concomitant full-thickness cartilage lesion, compared to patients without such lesions.

Cartilage lesions; a prognostic factor?

The current study is one of very few level-1, prognostic studies investigating the mid- to long term patient-reported outcome after ACL-reconstruction performed in patients with a concomitant full-thickness cartilage lesion.

89 patients 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). Knee Injury and Osteoarthritis Outcome Score (KOOS), was used as the main outcome measure.

Secondary outcomes included radiographic evaluation according to the Kell- gren–Lawrence criteria of knee osteoarthritis (OA) and Tegner activity score.

No difference in patient-reported knee function;

No statistically significant differences in KOOS were detected between the two groups. Radiographic knee OA of the affected knee, defined as Kellgren and Lawrence ≥2, was significantly more frequent in subjects without a concomitant cartilage lesion.

Interestingly, even though most study patients did not receive any cartilage treatment at the time of ACLR, a continued improvement in KOOS scores over time was observed. That observation highlights the need of larger prospective cohort studies, or randomized controlled trials, to investigate the effectiveness of surgical intervention on these cartilage lesions. 

Get more information about the study and download the paper in KSSTA.