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Knee Surgery, Sports Traumatology, Arthroscopy
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2017

04.04.2016 | Knee

Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2017

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Abstract

Purpose

To document the available evidence on the influence of cartilage lesions on the results of anterior cruciate ligament (ACL) surgery and their management to optimize the final outcome.

Methods

A systematic review was performed on the PubMed database on articles dealing with cartilage lesions detected at the time of ACL reconstruction, by looking both for their influence on the clinical outcome and the results of their treatment. Reports on clinical, radiological, or second-look outcomes at any follow-up were included. Exclusion criteria were preclinical studies, reviews, or studies not reporting clinical, radiological, or second-look outcome after primary ACL reconstruction.

Results

Thirty-seven studies were included for the final analysis. Twenty-seven focused on the influence of cartilage lesions on clinical outcome after ACL reconstruction in 47,837 patients. In total, 21/27 articles showed a correlation with a poorer outcome in terms of subjective, objective, and radiographic findings. Lesion location and depth influenced final results. Only 9.0 % of these defects were treated in the analysed studies, and only 10 manuscripts of overall low level evaluated the results of combined cartilage–ACL treatments.

Conclusion

The majority of the literature supports the clinical relevance of cartilage lesions which are correlated with a poorer outcome after ACL reconstruction. Nonetheless, a large amount of chondral defects are actually not addressed, also considering the poor evidence for the benefits provided by cartilage treatments. In fact, only a few studies specifically focused on how to manage cartilage lesions found during ACL reconstruction and there is a lack of indications for the most appropriate treatment approach.

Level of evidence

IV.
Literatur
1.
2.
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(1):48–53PubMedCrossRef
3.
Andernord D, Bjornsson H, Petzold M, Eriksson BI, Forssblad M, Karlsson J, Samuelsson K (2014) Surgical predictors of early revision surgery after anterior cruciate ligament reconstruction: results from the swedish national knee ligament register on 13,102 Patients. Am J Sports Med 42(7):1574–1582PubMedCrossRef
4.
Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43(2):275–281PubMedCrossRef
5.
6.
Andriolo L, Filardo G, Kon E, Ricci M, Della Villa F, Della Villa S, Zaffagnini S, Marcacci M (2015) Revision anterior cruciate ligament reconstruction: clinical outcome and evidence for return to sport. Knee Surg Sports Traumatol Arthrosc 23(10):2825–2845PubMedCrossRef
7.
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606PubMedCrossRef
8.
Asano H, Muneta T, Ikeda H, Yagishita K, Kurihara Y, Sekiya I (2004) Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients. Arthroscopy 20(5):474–481PubMedCrossRef
9.
Asano H, Muneta T, Shinomiya K (2002) Evaluation of clinical factors affecting knee pain after anterior cruciate ligament reconstruction. J Knee Surg 15(1):23–28PubMed
10.
Barenius B, Forssblad M, Engstrom B, Eriksson K (2013) Functional recovery after anterior cruciate ligament reconstruction, a study of health-related quality of life based on the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc 21(4):914–927PubMedCrossRef
11.
Beaufils P, Hulet C, Dhenain M, Nizard R, Nourissat G, Pujol N (2009) Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthop Traumatol Surg Res 95(6):437–442PubMedCrossRef
12.
Benthien JP, Schwaninger M, Behrens P (2011) We do not have evidence based methods for the treatment of cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 19(4):543–552PubMedCrossRef
13.
Bonanzinga T, Signorelli C, Lopomo N, Grassi A, Neri MP, Filardo G, Zaffagnini S, Marcacci M (2015) Biomechanical effect of posterolateral corner sectioning after ACL injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 23(10):2918–2924PubMedCrossRef
14.
Brophy RH, Zeltser D, Wright RW, Flanigan D (2010) Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy 26(1):112–120PubMedCrossRef
15.
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):1058–1067PubMedPubMedCentralCrossRef
16.
Csintalan RP, Inacio MC, Funahashi TT, Maletis GB (2014) Risk factors of subsequent operations after primary anterior cruciate ligament reconstruction. Am J Sports Med 42(3):619–625PubMedCrossRef
17.
de Girolamo L, Galliera E, Volpi P, Denti M, Dogliotti G, Quaglia A, Cabitza P, Corsi Romanelli MM, Randelli P (2015) Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation. Knee Surg Sports Traumatol Arthrosc 23(1):90–96PubMedCrossRef
18.
Del Torto M, Enea D, Panfoli N, Filardo G, Pace N, Chiusaroli M (2015) Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix. Knee Surg Sports Traumatol Arthrosc 23(12):3614–3622PubMedCrossRef
19.
Dhinsa BS, Nawaz SZ, Gallagher KR, Skinner J, Briggs T, Bentley G (2015) Outcome of combined autologous chondrocyte implantation and anterior cruciate ligament reconstruction. Indian J Orthop 49(2):155–163PubMedPubMedCentralCrossRef
20.
Dunn WR, Wolf BR, Harrell FE Jr, Reinke EK, Huston LJ, Spindler KP (2015) Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years. J Bone Joint Surg Am 97(7):551–557PubMedPubMedCentralCrossRef
21.
Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27(4):489–494PubMedCrossRef
22.
Filardo G, Kon E, Andriolo L, Di Matteo B, Balboni F, Marcacci M (2014) Clinical profiling in cartilage regeneration: prognostic factors for midterm results of matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 42(4):898–905PubMedCrossRef
23.
Filardo G, Kon E, Andriolo L, Vannini F, Buda R, Ferruzzi A, Giannini S, Marcacci M (2013) Does patient sex influence cartilage surgery outcome? Analysis of results at 5-year follow-up in a large cohort of patients treated with Matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 41(8):1827–1834PubMedCrossRef
24.
Filardo G, Kon E, Tentoni F, Andriolo L, Di Martino A, Busacca M, Di Matteo B, Marcacci M (2016) Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis. Int Orthop 40(1):183–190PubMedCrossRef
25.
Fowler PJ (1994) Bone injuries associated with anterior cruciate ligament disruption. Arthroscopy 10(4):453–460PubMedCrossRef
26.
Gaweda K, Walawski J, Weglowski R, Patyra M (2006) Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting. Int Orthop 30(3):185–189PubMedPubMedCentralCrossRef
27.
Ghodadra N, Mall NA, Karas V, Grumet RC, Kirk S, McNickle AG, Garrido CP, Cole BJ, Bach BR Jr (2013) Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg 26(3):185–193PubMedCrossRef
28.
Griffith TB, Allen BJ, Levy BA, Stuart MJ, Dahm DL (2013) Outcomes of repeat revision anterior cruciate ligament reconstruction. Am J Sports Med 41(6):1296–1301PubMedCrossRef
29.
Gudas R, Gudaite A, Mickevicius T, Masiulis N, Simonaityte R, Cekanauskas E, Skurvydas A (2013) Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: a prospective study with a 3-year follow-up. Arthroscopy 29(1):89–97PubMedCrossRef
30.
Gudas R, Gudaite A, Pocius A, Gudiene A, Cekanauskas E, Monastyreckiene E, Basevicius A (2012) Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med 40(11):2499–2508PubMedCrossRef
31.
Guettler JH, Demetropoulos CK, Yang KH, Jurist KA (2004) Osteochondral defects in the human knee: influence of defect size on cartilage rim stress and load redistribution to surrounding cartilage. Am J Sports Med 32(6):1451–1458PubMedCrossRef
32.
Hanypsiak BT, Spindler KP, Rothrock CR, Calabrese GJ, Richmond B, Herrenbruck TM, Parker RD (2008) Twelve-year follow-up on anterior cruciate ligament reconstruction: long-term outcomes of prospectively studied osseous and articular injuries. Am J Sports Med 36(4):671–677PubMedCrossRef
33.
Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J, Van Dijk CN (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):423–435PubMedCrossRef
34.
Hirose J, Nishioka H, Okamoto N, Oniki Y, Nakamura E, Yamashita Y, Usuku K, Mizuta H (2013) Articular cartilage lesions increase early cartilage degeneration in knees treated by anterior cruciate ligament reconstruction: t1rho mapping evaluation and 1-year follow-up. Am J Sports Med 41(10):2353–2361PubMedCrossRef
35.
Ichiba A, Kishimoto I (2009) Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old. Arch Orthop Trauma Surg 129(3):409–415PubMedCrossRef
36.
Imade S, Kumahashi N, Kuwata S, Kadowaki M, Tanaka T, Takuwa H, Uchio Y (2013) A comparison of patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting for the treatment of articular cartilage defects combined with anterior cruciate ligament injury. Knee 20(5):354–359PubMedCrossRef
37.
Kim DK, Park WH (2015) Sex differences in knee strength deficit 1 year after anterior cruciate ligament reconstruction. J Phys Ther Sci 27(12):3847–3849PubMedPubMedCentralCrossRef
38.
Klinger HM, Baums MH, Otte S, Steckel H (2003) Anterior cruciate reconstruction combined with autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 11(6):366–371PubMedCrossRef
39.
Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2015) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-015-3830-2 PubMed
40.
Krych AJ, Woodcock JA, Morgan JA, Levy BA, Stuart MJ, Dahm DL (2015) Factors associated with excellent 6-month functional and isokinetic test results following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 23(4):1053–1059PubMedCrossRef
41.
Lebel B, Hulet C, Galaud B, Burdin G, Locker B, Vielpeau C (2008) Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up. Am J Sports Med 36(7):1275–1282PubMedCrossRef
42.
Levy AS, Meier SW (2003) Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 34(1):149–167PubMedCrossRef
43.
Magnussen RA, Verlage M, Flanigan DC, Kaeding CC, Spindler KP (2015) Patient-reported outcomes and their predictors at minimum 10 years after anterior cruciate ligament reconstruction: a systematic review of prospectively collected data. Orthop J Sports Med 3(3):2325967115573706PubMedPubMedCentralCrossRef
44.
Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr, Paletta GA Jr (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42(10):2363–2370PubMedCrossRef
45.
Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR Jr (2015) Results after anterior cruciate ligament reconstruction in patients older than 40 years: How do they compare with younger patients?. Sports Health, A systematic review and comparison with younger populations. doi:10.​1177/​1941738115622138​
46.
Marcacci M, Filardo G, Kon E (2013) Treatment of cartilage lesions: what works and why? Injury 44(Suppl 1):S11–S15PubMedCrossRef
47.
McAllister DR, Foster B, Martin DE, Veitch AJ, Dorey FJ, Petrigliano F, Hame SL (2014) Outcome of chronic isolated anterior cruciate ligament reconstruction. J Knee Surg 27(5):383–392PubMedCrossRef
48.
Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME (2015) Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores. Knee Surg Sports Traumatol Arthrosc 23(1):232–239PubMedCrossRef
49.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedPubMedCentralCrossRef
50.
Murray JR, Lindh AM, Hogan NA, Trezies AJ, Hutchinson JW, Parish E, Read JW, Cross MV (2012) Does anterior cruciate ligament reconstruction lead to degenerative disease?: thirteen-year results after bone-patellar tendon-bone autograft. Am J Sports Med 40(2):404–413PubMedCrossRef
51.
Nakamura N, Horibe S, Toritsuka Y, Mitsuoka T, Natsu-ume T, Yoneda K, Hamada M, Tanaka Y, Boorman RS, Yoshikawa H, Shino K (2008) The location-specific healing response of damaged articular cartilage after ACL reconstruction: short-term follow-up. Knee Surg Sports Traumatol Arthrosc 16(9):843–848PubMedCrossRef
52.
Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38(11):2201–2210PubMedCrossRef
53.
Osti L, Papalia R, Del Buono A, Amato C, Denaro V, Maffulli N (2010) Good results five years after surgical management of anterior cruciate ligament tears, and meniscal and cartilage injuries. Knee Surg Sports Traumatol Arthrosc 18(10):1385–1390PubMedCrossRef
54.
Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P (2010) Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med 38(6):1094–1102PubMedCrossRef
55.
Potter HG, Jain SK, Ma Y, Black BR, Fung S, Lyman S (2012) Cartilage injury after acute, isolated anterior cruciate ligament tear: immediate and longitudinal effect with clinical/MRI follow-up. Am J Sports Med 40(2):276–285PubMedCrossRef
56.
Ralles S, Agel J, Obermeier M, Tompkins M (2015) Incidence of secondary intra-articular injuries with time to anterior cruciate ligament reconstruction. Am J Sports Med 43(6):1373–1379PubMedCrossRef
57.
58.
Rotterud JH, Risberg MA, Engebretsen L, Aroen A (2012) Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up. Knee Surg Sports Traumatol Arthrosc 20(8):1533–1539PubMedCrossRef
59.
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):535–543PubMedCrossRef
60.
Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2016) Effect on patient-reported outcomes of debridement or microfracture of concomitant full-thickness cartilage lesions in anterior cruciate ligament-reconstructed knees: a nationwide cohort study from Norway and Sweden of 357 patients with 2-year follow-up. Am J Sports Med 44(2):337–344PubMedCrossRef
61.
Sandon A, Werner S, Forssblad M (2015) Factors associated with returning to football after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23(9):2514–2521PubMedCrossRef
62.
Shelbourne KD, Gray T (2000) Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med 28(4):446–452PubMedCrossRef
63.
Shelbourne KD, Gray T (2009) Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 37(3):471–480PubMedCrossRef
64.
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(2):8–16PubMedCrossRef
65.
Signorelli C, Bonanzinga T, Lopomo N, Marcheggiani Muccioli GM, Bignozzi S, Filardo G, Zaffagnini S, Marcacci M (2013) Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction? Scand J Med Sci Sports 23(4):e219–e224PubMedCrossRef
66.
Su F, Hilton JF, Nardo L, Wu S, Liang F, Link TM, Ma CB, Li X (2013) Cartilage morphology and T1rho and T2 quantification in ACL-reconstructed knees: a 2-year follow-up. Osteoarthritis Cartilage 21(8):1058–1067PubMedPubMedCentralCrossRef
67.
Tahami SM, Rad SM (2015) Outcome of ACL reconstruction and concomitant articular injury treatment. Arch Bone Jt Surg 3(4):260–263PubMedPubMedCentral
68.
Theologis AA, Kuo D, Cheng J, Bolbos RI, Carballido-Gamio J, Ma CB, Li X (2011) Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1rho) magnetic resonance imaging: 1-year cohort study. Arthroscopy 27(1):65–76PubMedCrossRef
69.
van Duijvenbode DC, Jonkers FJ, Konst YE, van Royen BJ, Benink RJ, Hoozemans MJ (2016) Gel-type autologous chondrocyte implantation for cartilage repair in patients with prior ACL reconstruction: a retrospective two year follow-up. Knee 23(2):241–245PubMedCrossRef
70.
Wasserstein D, Huston LJ, Nwosu S, Spindler KP (2015) KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a multicenter orthopaedic outcomes network (MOON) prospective longitudinal cohort study. Osteoarthritis Cartilage 23(10):1674–1684PubMedPubMedCentralCrossRef
71.
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(4):688–692PubMedCrossRef
Metadaten
Titel
Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review
Publikationsdatum
04.04.2016
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2017
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4097-y

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