title: Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees: A Nationwide Cohort Study From Norway and Sweden of 357 Patients With 2-Year Follow-up.
abstract: BACKGROUND
  The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)-injured knees is debatable.
  
  
  OBJECTIVE
  To evaluate the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcomes after ACL reconstruction.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  Six hundred forty-four patients who underwent primary unilateral ACL reconstruction and had a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n = 129) or MF (n = 164), or underwent no treatment (n = 351) of the cartilage lesion, registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcomes. At a mean follow-up of 2.1 ± 0.2 years after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or MF on the KOOS.
  
  
  RESULTS
  No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. The MF treatment of the cartilage lesions had significant negative effects at 2-year follow-up on the KOOS Sport and Recreation (Sport/Rec) (regression coefficient [β] = -8.9; 95% confidence interval [CI], -15.1 to -1.5) and Knee-Related Quality of Life (QoL) (β = -8.1; 95% CI, -14.1 to -2.1) subscales in the unadjusted analyses. When adjusting for confounders, MF had significant negative effects on the same KOOS subscales of Sport/Rec (β = -8.6; 95% CI, -16.4 to -0.7) and QoL (β = -7.2; 95% CI, -13.6 to -0.8). For the remaining KOOS subscales of Pain, Symptoms, and Activities of Daily Living, there were no significant unadjusted or adjusted effects of MF.
  
  
  CONCLUSIONS
  MF of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction.
authors.affiliation: Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway janhrot@medisin.uio.no.
authors.forename: Jan Harald
authors.initials: JH
authors.lastname: Røtterud
authors.affiliation: Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Einar Andreas
authors.initials: EA
authors.lastname: Sivertsen
authors.affiliation: Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Forssblad
authors.affiliation: Oslo Sports Trauma Research Center, Oslo, Norway Department of Orthopedics, Oslo University Hospital, Oslo, Norway Norwegian Cruciate Ligament Register, Bergen, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway Oslo Sports Trauma Research Center, Oslo, Norway.
authors.forename: Asbjørn
authors.initials: A
authors.lastname: Årøen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D003646:Debridement / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D050724:Fractures, Cartilage / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007718:Knee Injuries / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D063868:Patient Outcome Assessment; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
keywords: KOOS; anterior cruciate ligament; articular cartilage; debridement; knee; microfracture