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
Background: The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable. Purpose: To evaluate the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grad...
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| Veröffentlicht in: | The American journal of sports medicine 2016-02, Vol.44 (2), p.337-344 |
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| creator | Røtterud, Jan Harald Sivertsen, Einar Andreas Forssblad, Magnus Engebretsen, Lars Årøen, Asbjørn |
| description | Background:
The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable.
Purpose:
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.
Study Design:
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.
Conclusion:
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. |
| doi_str_mv | 10.1177/0363546515617468 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_508710</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546515617468</sage_id><sourcerecordid>1765985847</sourcerecordid><originalsourceid>FETCH-LOGICAL-c389t-90e461849be81e69e55bdbbbab4b19a9060ceb7560bab24f4a410223083c78423</originalsourceid><addsrcrecordid>eNqNks1u1DAQxy0EokvhzglZ4sIlYCf-yrFKP0AsKqrKObK9k-I2sRfbEeLGO_QheC-eBEe7VFUlJE625v-bv2c8g9BLSt5SKuU70oiGM8EpF1QyoR6hFeW8rppG8MdotcjVoh-gZyldE0KoFOopOqiF4FJxukK_ToYBbMbB4886O_C5uoBtiBk2-HzONkyQcBjwMZjoNjAVAIeIPzkbwxC1zXOERe-CL6zLuuin8zhWl1-dvfGQEu50zG7UV4DXkFzwCTuPj3yG6IpTF2frdC6iu9KL_e-ftxdgC5aLspTx0QOk5-jJoMcEL_bnIfpyenLZva_W52cfuqN1ZRvV5qolwARVrDWgKIgWODcbY4w2zNBWt0QQC0ZyQUqoZgPTjJK6bohqrFSsbg5RtfNN32E7m34b3aTjjz5o1-9DN-UGPSdKUlL4Nzt-G8O3GVLuJ5csjKP2EObUlw_nreKKyf9B64ZxwXlBXz9Ar8McfWl8oaRoi58qFNlRZRYpRRjuqqWkX_ajf7gfJeXV3ng2E2zuEv4uxL3-y8Duvfovwz99a8Wc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1767698478</pqid></control><display><type>article</type><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</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Røtterud, Jan Harald ; Sivertsen, Einar Andreas ; Forssblad, Magnus ; Engebretsen, Lars ; Årøen, Asbjørn</creator><creatorcontrib>Røtterud, Jan Harald ; Sivertsen, Einar Andreas ; Forssblad, Magnus ; Engebretsen, Lars ; Årøen, Asbjørn</creatorcontrib><description>Background:
The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable.
Purpose:
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.
Study Design:
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.
Conclusion:
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.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546515617468</identifier><identifier>PMID: 26657851</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Activities of Daily Living ; Adult ; Aged ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction - methods ; Cartilage ; Cartilage, Articular - injuries ; Cartilage, Articular - surgery ; Cohort Studies ; Debridement - statistics & numerical data ; Female ; Follow-Up Studies ; Fractures, Cartilage - epidemiology ; Fractures, Cartilage - pathology ; Humans ; Knee ; Knee Injuries - epidemiology ; Knee Injuries - pathology ; Ligaments ; Male ; Middle Aged ; Norway - epidemiology ; Patient Outcome Assessment ; Quality of Life ; Registries ; Regression analysis ; Sports injuries ; Sports medicine ; Surveys and Questionnaires ; Sweden - epidemiology</subject><ispartof>The American journal of sports medicine, 2016-02, Vol.44 (2), p.337-344</ispartof><rights>2015 The Author(s)</rights><rights>2015 The Author(s).</rights><rights>Copyright Sage Publications Ltd. Feb 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c389t-90e461849be81e69e55bdbbbab4b19a9060ceb7560bab24f4a410223083c78423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546515617468$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546515617468$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26657851$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:132932463$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Røtterud, Jan Harald</creatorcontrib><creatorcontrib>Sivertsen, Einar Andreas</creatorcontrib><creatorcontrib>Forssblad, Magnus</creatorcontrib><creatorcontrib>Engebretsen, Lars</creatorcontrib><creatorcontrib>Årøen, Asbjørn</creatorcontrib><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</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable.
Purpose:
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.
Study Design:
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.
Conclusion:
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.</description><subject>Activities of Daily Living</subject><subject>Adult</subject><subject>Aged</subject><subject>Anterior Cruciate Ligament - surgery</subject><subject>Anterior Cruciate Ligament Injuries</subject><subject>Anterior Cruciate Ligament Reconstruction - methods</subject><subject>Cartilage</subject><subject>Cartilage, Articular - injuries</subject><subject>Cartilage, Articular - surgery</subject><subject>Cohort Studies</subject><subject>Debridement - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures, Cartilage - epidemiology</subject><subject>Fractures, Cartilage - pathology</subject><subject>Humans</subject><subject>Knee</subject><subject>Knee Injuries - epidemiology</subject><subject>Knee Injuries - pathology</subject><subject>Ligaments</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Norway - epidemiology</subject><subject>Patient Outcome Assessment</subject><subject>Quality of Life</subject><subject>Registries</subject><subject>Regression analysis</subject><subject>Sports injuries</subject><subject>Sports medicine</subject><subject>Surveys and Questionnaires</subject><subject>Sweden - epidemiology</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks1u1DAQxy0EokvhzglZ4sIlYCf-yrFKP0AsKqrKObK9k-I2sRfbEeLGO_QheC-eBEe7VFUlJE625v-bv2c8g9BLSt5SKuU70oiGM8EpF1QyoR6hFeW8rppG8MdotcjVoh-gZyldE0KoFOopOqiF4FJxukK_ToYBbMbB4886O_C5uoBtiBk2-HzONkyQcBjwMZjoNjAVAIeIPzkbwxC1zXOERe-CL6zLuuin8zhWl1-dvfGQEu50zG7UV4DXkFzwCTuPj3yG6IpTF2frdC6iu9KL_e-ftxdgC5aLspTx0QOk5-jJoMcEL_bnIfpyenLZva_W52cfuqN1ZRvV5qolwARVrDWgKIgWODcbY4w2zNBWt0QQC0ZyQUqoZgPTjJK6bohqrFSsbg5RtfNN32E7m34b3aTjjz5o1-9DN-UGPSdKUlL4Nzt-G8O3GVLuJ5csjKP2EObUlw_nreKKyf9B64ZxwXlBXz9Ar8McfWl8oaRoi58qFNlRZRYpRRjuqqWkX_ajf7gfJeXV3ng2E2zuEv4uxL3-y8Duvfovwz99a8Wc</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Røtterud, Jan Harald</creator><creator>Sivertsen, Einar Andreas</creator><creator>Forssblad, Magnus</creator><creator>Engebretsen, Lars</creator><creator>Årøen, Asbjørn</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>20160201</creationdate><title>Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees</title><author>Røtterud, Jan Harald ; Sivertsen, Einar Andreas ; Forssblad, Magnus ; Engebretsen, Lars ; Årøen, Asbjørn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-90e461849be81e69e55bdbbbab4b19a9060ceb7560bab24f4a410223083c78423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Activities of Daily Living</topic><topic>Adult</topic><topic>Aged</topic><topic>Anterior Cruciate Ligament - surgery</topic><topic>Anterior Cruciate Ligament Injuries</topic><topic>Anterior Cruciate Ligament Reconstruction - methods</topic><topic>Cartilage</topic><topic>Cartilage, Articular - injuries</topic><topic>Cartilage, Articular - surgery</topic><topic>Cohort Studies</topic><topic>Debridement - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures, Cartilage - epidemiology</topic><topic>Fractures, Cartilage - pathology</topic><topic>Humans</topic><topic>Knee</topic><topic>Knee Injuries - epidemiology</topic><topic>Knee Injuries - pathology</topic><topic>Ligaments</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Norway - epidemiology</topic><topic>Patient Outcome Assessment</topic><topic>Quality of Life</topic><topic>Registries</topic><topic>Regression analysis</topic><topic>Sports injuries</topic><topic>Sports medicine</topic><topic>Surveys and Questionnaires</topic><topic>Sweden - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Røtterud, Jan Harald</creatorcontrib><creatorcontrib>Sivertsen, Einar Andreas</creatorcontrib><creatorcontrib>Forssblad, Magnus</creatorcontrib><creatorcontrib>Engebretsen, Lars</creatorcontrib><creatorcontrib>Årøen, Asbjørn</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Røtterud, Jan Harald</au><au>Sivertsen, Einar Andreas</au><au>Forssblad, Magnus</au><au>Engebretsen, Lars</au><au>Årøen, Asbjørn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>44</volume><issue>2</issue><spage>337</spage><epage>344</epage><pages>337-344</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background:
The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable.
Purpose:
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.
Study Design:
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.
Conclusion:
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.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26657851</pmid><doi>10.1177/0363546515617468</doi><tpages>8</tpages></addata></record> |
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| ispartof | The American journal of sports medicine, 2016-02, Vol.44 (2), p.337-344 |
| issn | 0363-5465 1552-3365 |
| language | eng |
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| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Activities of Daily Living Adult Aged Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Anterior Cruciate Ligament Reconstruction - methods Cartilage Cartilage, Articular - injuries Cartilage, Articular - surgery Cohort Studies Debridement - statistics & numerical data Female Follow-Up Studies Fractures, Cartilage - epidemiology Fractures, Cartilage - pathology Humans Knee Knee Injuries - epidemiology Knee Injuries - pathology Ligaments Male Middle Aged Norway - epidemiology Patient Outcome Assessment Quality of Life Registries Regression analysis Sports injuries Sports medicine Surveys and Questionnaires Sweden - epidemiology |
| 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 |
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