Considerations for Treatment of Concomitant Cartilage and ACL Injury

Debridement

Microfracture

KOOS subscales

95 % CI

Pain

332

0.1

(−4.2 to 4.5)

−4.2

(−8.6 to 0.2)

Symptoms

335

1.0

(−3.8 to 5.7)

−3.3

(−8.2 to 1.5)

ADL

333

1.8

(−2.1 to 5.7)

−2.7

(−6.6 to 1.2)

Sport/rec

334

−0.2

(−7.9 to 7.5)

−8.6

(−16.4 to −0.7)

0.032

QoL

335

2.1

(−4.3 to 8.4)

−7.2

(−13.6 to −0.8)

0.028

Adjusted for gender, age, previous ipsilateral knee surgery, time from injury to surgery, concomitant ligament injury, concomitant meniscal lesion(s), meniscus resection, type of ACL graft, area of cartilage lesion, depth (ICRS grade) of cartilage lesion, location of cartilage lesion, and preoperative KOOS scores

No treatment of cartilage lesions used as reference

ADL activities in daily living, QoL quality of life, N number of patients included in the regression analyses, β regression coefficient, CI confidence interval, p level of significance, ns not significant

42.3 Conclusions on Treatment Strategies

Since there is no evidence that surgical treatment of a concomitant cartilage lesion in ACL-injured knees will reduce the risk of later OA, surgical treatment of these cartilage lesions should be restricted to symptomatic lesions.

Even for symptomatic lesions, to date, none of the surgical treatment options for concomitant cartilage lesions in ACL-injured knees are proven to be superior compared to leaving these cartilage lesions untreated. Microfracture of concomitant full-thickness cartilage lesions in ACL-injured knees should probably be avoided until future studies have identified if there are any subgroups of patients that might benefit from microfracture of cartilage lesions at the time of ACL reconstruction.

Some selected ACL-injured patients that are well suited for cartilage surgery might benefit from surgical treatment of concomitant cartilage lesions. For unstable lesions, debridement is a simple and easy procedure to perform, which might relieve symptoms. However, current evidence suggests that no treatment of the cartilage lesions is a safe and sound first-line option in the majority of ACL-injured patients.

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 7:69–74CrossrefPubMed

Amin AA, Bartlett W, Gooding CR, Sood M, Skinner JA, Carrington RW, Briggs TW, Bentley G (2006) The use of autologous chondrocyte implantation following and combined with anterior cruciate ligament reconstruction. Int Orthop 30:48–53CrossrefPubMed

Behery O, Siston RA, Harris JD, Flanigan DC (2014) Treatment of cartilage defects of the knee: expanding on the existing algorithm. Clin J Sport Med 24:21–30CrossrefPubMed

Bekkers JE, Inklaar M, Saris DB (2009) Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med 37(Suppl 1):148S–155SCrossrefPubMed

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