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Considerations for Treatment of Concomitant Cartilage and ACL Injury

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

Concomitant cartilage lesions in ACL-injured knees are common. These cartilage lesions have negative effects on patient-reported outcome after ACL reconstruction and increase the risk of later osteoarthritis (OA).

A cartilage lesion present at the time of ACL reconstruction can either be left untreated or treated surgically. However, regarding patient-reported outcome and later OA, 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. Even though some selected ACL-injured patients might benefit from surgical treatment of concomitant cartilage lesions, current evidence suggests that no treatment of concomitant cartilage lesions is a safe and sound first-line option in the majority of ACL-injured patients.

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References

  1. 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 7:69–74

    Article  CAS  PubMed  Google Scholar 

  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 30:48–53

    Article  CAS  PubMed  Google Scholar 

  3. 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 24:21–30

    Article  PubMed  Google Scholar 

  4. 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–155S

    Article  PubMed  Google Scholar 

  5. Bobic V (1996) Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 3:262–264

    Article  CAS  PubMed  Google Scholar 

  6. Brittberg M, Peterson L (1998) Introduction of an articular cartilage classification. ICRS Newsl 1:5–8

    Google Scholar 

  7. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69

    Article  Google Scholar 

  8. Brophy RH, Zeltser D, Wright RW, Flanigan D (2010) Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy 26:112–120

    Article  PubMed  Google Scholar 

  9. 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 42:1058–1067

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gaweda K, Walawski J, Weglowski R, Patyra M (2006) Rehabilitation after one-stage anterior cruciate reconstruction and osteochondral grafting. Int Orthop 30:185–189

    Article  PubMed  PubMed Central  Google Scholar 

  11. Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop 83:577–582

    Article  PubMed  PubMed Central  Google Scholar 

  12. 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 29:89–97

    Article  PubMed  Google Scholar 

  13. Hjermundrud V, Bjune TK, Risberg MA, Engebretsen L, Årøen A (2010) Full-thickness cartilage lesion do not affect knee function in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 18:298–303

    Article  PubMed  Google Scholar 

  14. Hunt MA, Pollock CL, Kraus VB, Saxne T, Peters S, Huebner JL, Sayre EC, Cibere J (2013) Relationships amongst osteoarthritis biomarkers, dynamic knee joint load, and exercise: results from a randomized controlled pilot study. BMC Musculoskelet Disord 14:115

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. 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 20:354–359

    Article  PubMed  Google Scholar 

  16. Inacio MC, Chen Y, Maletis GB, Ake CF, Fithian DC, Granan LP (2014) Injury pathology at the time of anterior cruciate ligament reconstruction associations with self-assessment of knee function. Clin J Sport Med 24:461–467

    Article  PubMed  Google Scholar 

  17. Janssen RP, du Mée 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 21:1977–1988

    Google Scholar 

  18. Klinger HM, Baums MH, Otte S, Steckel H (2003) Anterior cruciate reconstruction combined with autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 11:366–371

    Article  PubMed  Google Scholar 

  19. Li RT, Lorenz S, Xu Y, Harner CD, Fu FH, Irrgang JJ (2011) Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction. Am J Sports Med 39:2595–2603

    Article  PubMed  Google Scholar 

  20. Mithoefer K, Williams RJ III, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920

    Article  PubMed  Google Scholar 

  21. Osti L, Papalia R, Del BA, 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 18:1385–1390

    Article  PubMed  Google Scholar 

  22. Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 322:212–234

    Google Scholar 

  23. Røtterud JH, Reinholt FP, Beckstrøm KJ, Risberg MA, Årøen A (2014) Relationship between CTX-II and patient characteristics, patient-reported outcome, muscle strength, and rehabilitation in patients with a focal cartilage lesion of the knee: a prospective exploratory cohort study of 48 patients. BMC Musculoskelet Disord 15:99

    Article  PubMed  PubMed Central  Google Scholar 

  24. Røtterud JH, Risberg MA, Engebretsen L, Årøen 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 20:1533–1539

    Article  PubMed  Google Scholar 

  25. 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 39:1387–1394

    Article  PubMed  Google Scholar 

  26. Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen 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 41:535–543

    Article  PubMed  Google Scholar 

  27. Røtterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Årøen A (2015) 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 44:337–344

    Article  PubMed  Google Scholar 

  28. Wondrasch B, Årøen A, Røtterud JH, Høysveen T, Bølstad K, Risberg MA (2013) The feasibility of a 3-month active rehabilitation program for patients with knee full-thickness articular cartilage lesions: the Oslo cartilage active rehabilitation and education study. J Orthop Sports Phys Ther 43:310–324

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway

    Jan Harald Røtterud

  2. Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway

    Lars Engebretsen

Authors
  1. Jan Harald Røtterud
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  2. Lars Engebretsen
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Correspondence to Lars Engebretsen .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Røtterud, J.H., Engebretsen, L. (2017). Considerations for Treatment of Concomitant Cartilage and ACL Injury. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_42

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_42

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

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