Abstract
Anterior cruciate ligament (ACL) tears with concomitant cartilage injuries resulting
in ACL reconstruction (ACLR) with cartilaginous procedures are common in the young,
high-demand population. The purpose of this study was to report and characterize cartilage
treatments performed at the time of index ACLR reconstruction and to determine if
those treatments are associated with revision surgery (of any kind) in the 4-year
follow-up. We performed a consecutive series of active duty service members in the
Military Health System Data Repository with ACLR with and without concomitant cartilage
procedures done at military facilities between October 2008 and September 2011. Patients
were continuously enrolled with no history of knee surgeries for 2 years prior to
primary ACLR. ACLR failure was defined as revision ACLR within 4 years following the
primary ACLR. Of the 2,735 primary ACLRs included in the study, 5.3% (143/2,735) underwent
isolated ACLR with a cartilage procedure. Of these patients, 23.07% (33/143) experienced
ACLR failure within 4 years after ACLR with cartilage procedures, including 33.33%
(11/33) undergoing revision ACLR. We found concomitant cartilage procedures at time
of index ACLR to have the following rates of revision 35.59% (21/59) for microfracture,
14.63% (6/41) for chondroplasty, and 13.95% (6/43) for osteochondral grafts. The overall
clinical failure rate of service members with ACLR plus concomitant cartilage procedure
is 23.07% with minimum 4-year follow-up. Further research should be done to identify
modifiable demographic and surgical factors associated with failure. This is a retrospective
case-control study that reflects level of evidence III.
Keywords
anterior cruciate ligament - anterior cruciate ligament reconstruction with cartilage
injury - anterior cruciate ligament reconstruction - incidence of chondral injury
with ACL rupture
