Giuseppe Filardo1, Francesca de Caro1, Luca Andriolo2, Elizaveta Kon1,3, Stefano Zaffagnini1, Maurilio Marcacci1. 1. II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy. 2. II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy. lucas.andriolo@gmail.com. 3. Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
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.
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.
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Authors: Volker Musahl; Ian D Engler; Ehab M Nazzal; Jonathan F Dalton; Gian Andrea Lucidi; Jonathan D Hughes; Stefano Zaffagnini; Francesco Della Villa; James J Irrgang; Freddie H Fu; Jon Karlsson Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-12-05 Impact factor: 4.342
Authors: Svend Ulstein; Asbjørn Årøen; Lars Engebretsen; Magnus Forssblad; Stein Håkon Låstad Lygre; Jan Harald Røtterud Journal: Orthop J Sports Med Date: 2018-07-24
Authors: Svend Ulstein; Asbjørn Årøen; Lars Engebretsen; Magnus Forssblad; Stein Håkon Låstad Lygre; Jan Harald Røtterud Journal: Orthop J Sports Med Date: 2018-08-01