• Author
    Dhruv Limaye
  • Discovery PI

    Thomas Kremen

  • Project Co-Author

    Andy Contreras, B.A, Tim Liu, M.D, Thomas Kremen, M.D.

  • Abstract Title

    Clinical Outcomes After Combined Anterior Cruciate Ligament Reconstruction and Cartilage Restoration: A Systematic Review and Exploratory Meta-Analysis

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Background: Concomitant focal cartilage lesions are frequently encountered upon anterior cruciate ligament (ACL) rupture and may adversely affect functional recovery if left untreated. While combined ACL reconstruction (ACLR) and cartilage restoration is increasingly performed, clinical outcomes across cartilage repair techniques remain incompletely characterized.

    Purpose: To systematically review the current evidence landscape for combined ACLR and cartilage restoration through patient-reported outcomes and return-to-sport (RTS) rates.

    Methods: A PRISMA-compliant systematic review was conducted using PubMed, Embase, and CENTRAL databases. Studies reporting clinical outcomes following concomitant ACLR and cartilage restoration with microfracture (MF), osteochondral autograft transfer (OAT), or autologous chondrocyte implantation (ACI/MACI) were included. Standardized mean differences (Hedges’ g) were calculated for patient-reported outcome measures across functional, pain, and activity domains using random-effects models.

    Results: Thirteen studies comprising 383 patients met inclusion criteria. Narrative synthesis identified consistent pre-to-post improvements across all included cohorts. Exploratory pooled analyses suggested large improvements in global knee function (Hedges’ g = 2.99; 95% CI, 1.76–4.22), pain (Hedges’ g = 1.31; 95% CI, 0.65–1.97), and activity (Hedges’ g = 4.24; 95% CI, 0.90–7.57), though substantial heterogeneity was present across domains.. OAT demonstrated the largest functional effect sizes (Hedges’ g = 4.5; 95% CI, 2.67–6.34), while ACI was associated with higher reoperation rates (25.1%). The pooled return-to-sport rate was 77.1%.

    Conclusion: This systematic review and narrative synthesis demonstrates consistent signals of clinically meaningful improvement in patient-reported outcomes following combined ACLR and cartilage restoration in young, active patients. Exploratory pooled analyses support these findings, though the evidence base is limited by study heterogeneity and small sample sizes. This review maps the current evidence landscape and identifies prospective comparative studies with standardized outcome reporting as the priority for future research.

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