Anterior Cruciate Ligament Reconstruction and Concomitant Focal Cartilage Lesions: A Systematic Review and Meta-Analysis of Prognosis after Surgical Treatment.

Abstract

To synthesize available evidence on the impact of concomitant focal cartilage lesions and their surgical treatment on clinical outcomes in the setting of anterior cruciate ligament (ACL)-reconstruction at short (6-36 months) and midterm (3-8 years) follow-up. Original level 1 or 2 studies comparing any patient-reported or objective outcomes in ACL-reconstructed patients (1) with and without concomitant focal cartilage lesion(s) or (2) after any type of cartilage surgical treatment were considered for inclusion. Systematic searches were conducted in MEDLINE via Ovid, Cochrane Library, EMBASE via OvidSP, and Web of Science. In meta-analysis performed across 6 studies (n=8,789 patients), we discovered with very low certainty, the correlation of concomitant any-thickness cartilage lesions and worse Patient-Reported Outcome Measure scores (PROMS) at cumulative short to mid, (pooled standardized mean difference (psmd) = -0.36; 95% confidence interval (CI) -0.62 to -0.10), short (psmd = -0.43; 95% CI = -0.94 to 0.08), and midterm (psmd = -0.22; 95% CI -0.43 to 0.00). Full-thickness lesions predicted worse PROMS with moderate certainty at cumulative short-midterm (psmd = -0.32; 95% CI = -0.41 to -0.23) and low certainty at both short (psmd = -0.45; 95% CI -0.83 to -0.07) and midterm (psmd = -0.30; 95% CI -0.38 to -0.22). In 4 studies for each outcome, mixed results were reported on osteoarthritis (OA) and reoperation rates. As the main finding, concomitant full-thickness cartilage lesions in ACL-reconstructed patients are a predictor of worse PROMS in the cumulative short to midterm. Correlations of any-thickness lesions or different cartilage treatments with short- or midterm PROMS, OA, or reoperation rates were either with very low certainty, unmeasured, or with mixed results.