Effect of Focal Cartilage Lesions on Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A 10-Year Nationwide Cohort Study of 7040 Patients

Background: Focal cartilage lesions are commonly associated with anterior cruciate ligament injuries. The long-term effect of these lesions on patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) remains unclear. Purpose: To determine the effect of cartilage lesions—partial thickness (International Cartilage Regeneration and Joint Preservation Society grades 1 and 2) and full thickness (grades 3 and 4)—on patient-reported outcomes 10 years after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The study included all patients with primary unilateral ACLR enrolled in the Norwegian Knee Ligament Registry and Swedish Knee Ligament Registry from 2005 through 2008 (n = 15,783). At a mean follow-up of 10.1 years (SD, 0.2), 7040 (45%) patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS). Multiple linear regression analyses were used to evaluate any associations between concomitant cartilage lesions and KOOS outcomes 10 years after ACLR. Results: Of the 7040 patients available at 10-year follow-up, 1425 (20.3%) had partial-thickness cartilage lesions at the time of ACLR, and 495 (7.0%) had full-thickness cartilage lesions. Multiple linear regression analyses revealed that partial- and full-thickness cartilage lesions were associated with significantly inferior scores across all KOOS subscales as compared with patients without cartilage lesions. Patients with full-thickness lesions had less postoperative improvement after ACLR in all KOOS subscales as compared with patients with partial-thickness lesions. Conclusion: Patients with concomitant partial- or full-thickness cartilage lesions reported significantly worse outcomes in all KOOS subscales 10 years after ACLR as compared with patients without cartilage lesions.