Should articular cartilage lesions with ACL ruptures be treated at Recontruction
This review looks at 2 papers, one from Northern Europe in 2015, and one from North America in 2015. Articular cartilage damage often occurs at the time of ACL injury and whether to treat this or not has never been clearly established. Using micro fracture of the subchondral bone proposes to induce a fibrocartilaginous healing of the defect, but its efficacy is unclear. These reviews look at 2 papers.
One review from the American Journal of sports medicine in 2015 compared several common options for the treatment of articular cartilage lesions in knees that also underwent anterior cruciate ligament reconstruction (ACL) compared to no treatment at all versus debridement or micro fracture.
642 patients participated in this study and were divided into three groups. Group 1 had no treatment group 2 had debridement and group 3 underwent micro fracture.
The conclusion was that micro fracture of these four thickness cartilage lesions showed adverse effects on patient reported outcomes are to use follow-up after ACL reconstruction. Debridement of these lesions showed neither positive nor negative effects.
In another study performed by Shellborn in 2003, 125 articular cartilage defects were noted out of followed for a variable period averaging 6.3 years. One conclusion from the study is that these patients had very few problems in this time period.
These two studies call into question whether micro fracture at the time of ACL surgery is likely to be of benefit to the patient. Some longer term data will be useful in drawing a more solid conclusion.
References
Rotterud, Sievertsen, Forssblad, Endebretsen, Aroen. Effect on patient reported outcomes of the debridement or micro fracture of concomitant full thickness cartilage lesions in anterior cruciate ligament reconstructed knees. The American Journal of Sports Medicine 44(2) 2015
Shelbourne, Jari, Gray, 2003. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. Journal of Bone and Joint Surgery America, 2003;85