Debridement or Microfracture for Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament Reconstruction: A 10-Year Cohort Study of 326 Patients in Norway and Sweden.

BACKGROUND

It is well-established that patients undergoing anterior cruciate ligament reconstruction (ACLR) have a less favorable prognosis if a concomitant full-thickness cartilage lesion is present at the time of surgery. However, the long-term benefits of surgically addressing these cartilage lesions remain uncertain.

PURPOSE: To evaluate whether the most used surgical treatments for cartilage lesions influenced patient-reported outcomes 10 years after ACLR.

STUDY

DESIGN

Cohort study; Level of evidence, 2.

METHODS

This study was based on a cohort of all patients with primary unilateral ACLR in the Norwegian and Swedish knee ligament registries from January 2005 through December 2008 (n = 15,783). A total of 1012 (6.4%) patients had ≥1 full-thickness cartilage lesion (International Cartilage Regeneration & Joint Preservation Society grade 3 or 4) at the time of reconstruction. Of these, 644 patients met the inclusion criteria. At a mean (± SD) follow-up of 10.1 ± 0.2 years, 326 (51%) of the patients had completed the Knee injury and Osteoarthritis Outcome Score (KOOS). The treatment categories documented in the Scandinavian knee ligament registries were microfracture, debridement, no treatment, or other/unknown. Patients who did not receive surgical treatment for their full-thickness cartilage lesions served as the reference group and were compared with those who underwent microfracture or debridement. Multiple linear regression, with adjustment for possible confounders, was used to evaluate associations between surgical treatment of cartilage lesions and patient-reported outcomes for all KOOS subscales 10 years after ACLR.

RESULTS

Of the 326 patients available at the 10-year follow-up, 182 (56%) had not received surgical treatment for their cartilage lesions. A total of 68 (21%) patients had been treated with debridement, and 76 (23%) patients had been treated with microfracture. No significant association with KOOS scores was observed for debridement or microfracture compared with the reference group without surgical treatment of their cartilage lesion. The unadjusted data showed a trend toward poorer outcomes with microfracture compared with debridement, but this difference was not statistically significant.

CONCLUSION

Debridement and microfracture showed no significant association with patient-reported outcomes 10 years after ACLR in patients with concomitant full-thickness cartilage lesions, compared with those who did not receive surgical treatment for their cartilage lesion.