title: Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  IV.
authors.affiliation: II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Filardo
authors.affiliation: II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: de Caro
authors.affiliation: 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.
authors.forename: Luca
authors.identifier: http://orcid.org/0000-0001-6352-9671
authors.initials: L
authors.lastname: Andriolo
authors.affiliation: II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.|Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Kon
authors.affiliation: II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
authors.affiliation: II Orthopaedic and Traumatologic Clinic - Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000473:pathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D002358:Cartilage, Articular / Q000473:pathology*; D006801:Humans; D016896:Treatment Outcome
keywords: ACL; Cartilage treatment; Chondral lesion; Knee