Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: a prospective study with a 3-year follow-up.

PURPOSE: To compare the concomitant treatment of articular cartilage damage in the medial femoral condyle with osteochondral autologous transplantation (OAT), microfracture, or debridement procedures at the time of anterior cruciate ligament (ACL) reconstruction.

METHODS: Between 2006 and 2009, 102 patients with a mean age of 34.1 years and with an ACL rupture and articular cartilage damage in the medial femoral condyle of the knee were randomized to undergo OAT, microfractures, or debridement at the time of ACL reconstruction. A matched control group was included, comprising 34 patients with intact articular cartilage at the time of ACL reconstruction. There were 34 patients in the OAT-ACL group, 34 in the microfracture (MF)-ACL group, 34 in the debridement (D)-ACL group, and 34 in the control group with intact articular cartilage (IAC-ACL group). The mean time from ACL injury to operation was 19.32 ± 3.43 months, and the mean follow-up was 36.1 months (range, 34 to 37 months). Patients were evaluated with the International Knee Documentation Committee (IKDC) score, Tegner activity score, and clinical assessment.

RESULTS: Of 102 patients, 97 (95%) were available for the final follow-up. According to the subjective IKDC score, all 4 groups fared significantly better at the 3-year follow-up than preoperatively (P < .005). The OAT-ACL group's IKDC subjective knee evaluation was significantly better than that of the MF-ACL group (P = .024) and D-ACL group (P = .018). However, the IKDC subjective score of the IAC-ACL group was significantly better than the OAT-ACL group's IKDC evaluation (P = .043). There was no significant difference between the MF-ACL and D-ACL groups' IKDC subjective scores (P = .058). Evaluation of manual pivot-shift knee laxity according to the IKDC knee examination form showed similar findings for the 4 groups immediately postoperatively and at 3-year follow-up, and the findings were rated as normal or nearly normal (IKDC grade A or B) in 29 of 33 patients (88%) in the OAT-ACL group, 28 of 32 patients (88%) in the MF-ACL group, 27 of 32 patients (84%) in the D-ACL group, and 31 of 34 patients (91%) in the IAC-ACL group.

CONCLUSIONS: Our study shows that intact articular cartilage during ACL reconstruction yields more favorable IKDC subjective scores compared with any other articular cartilage surgery type. However, if an articular defect is present, the subjective IKDC scores are significantly better for OAT versus microfracture or debridement after a mean period of 3 years. Anterior knee stability results were not significantly affected by the different articular cartilage treatment methods.

LEVEL OF EVIDENCE: Level II, prospective comparative study.