Full-Thickness Cartilage Lesions Do Not Affect 10-Year Outcomes After ACL Reconstruction

Overview

This long-term study found no significant difference in patient-reported outcomes between ACL reconstruction patients with full-thickness cartilage lesions and matched controls without cartilage lesions at a minimum 10-year follow-up. Despite earlier reports of worse short-term outcomes, the presence of cartilage lesions did not influence Knee injury and Osteoarthritis Outcome Score (KOOS) results over the long term.

Background

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure often complicated by concomitant cartilage lesions, which occur in 16–46% of cases. The impact of these cartilage lesions on long-term patient outcomes remains unclear, with some studies suggesting poorer subjective outcomes and increased osteoarthritis risk, while others show minimal clinical relevance. This study aimed to clarify the long-term prognosis of ACL reconstruction patients with full-thickness cartilage lesions (ICRS grade 3 or 4) compared to matched controls without cartilage damage.

Data Highlights

Key Findings

• At a median 10.2-year follow-up, no significant differences were found in KOOS scores between patients with full-thickness cartilage lesions and matched controls without lesions.
• The primary outcome, KOOS quality of life subscale, showed no clinically relevant difference between groups.
• Earlier follow-ups showed worse outcomes in patients with cartilage lesions at 2 years but not at 6 or 10 years, indicating possible recovery over time.
• Only a minority (23%) of patients with cartilage lesions underwent cartilage-specific procedures during ACL reconstruction.
• Strict inclusion criteria and matching minimized confounding factors, isolating the effect of cartilage lesions on outcomes.
• No patients in either group had undergone total knee replacement at follow-up, suggesting low rates of severe joint degeneration.

Clinical Implications

Clinicians can counsel patients with full-thickness cartilage lesions undergoing ACL reconstruction that these lesions may not adversely affect long-term subjective knee function and quality of life. Routine cartilage procedures at the time of ACL reconstruction may not be necessary for all patients with such lesions, as untreated lesions did not worsen outcomes over a decade. Long-term monitoring remains important given the known association between cartilage damage and osteoarthritis risk.

Conclusion

This study demonstrates that full-thickness cartilage lesions do not significantly influence patient-reported outcomes after ACL reconstruction over a minimum 10-year period. These findings support a favorable long-term prognosis for ACL-injured patients with concomitant cartilage damage.

References

1. Hjermundrud et al. -- Index study on ACL reconstruction with cartilage lesions
2. Røtterud et al. -- 2-year outcomes after ACL reconstruction with cartilage lesions
3. Ulstein et al. -- 6-year follow-up of ACL reconstruction with cartilage lesions
4. National Knee Ligament Registry (NKLR) Norway -- Data source for ACL reconstruction outcomes