Strategy to adopt concerning cartilage lesions of the knee coupled with a rupture of anterior cruciate ligament : about a series of 30 patients.

The study of the results of a series of 30 patients operated on for asymptomatic (pain and unstability) association of a cartilaginouslesion and a rupture of the anterior cruciate ligament on a good axedknee, allowed us to suggest an adapted therapeutical strategy aimingat reducing the wrong prognosis usually given for this type ofassociation. The series included 26 men and 4 women, all athletic ata good level with an affected condylar lesion area of 6 cm2 or more,at stage 4 of Outerbridge for 24 patients. Twelve patients had undergoneprevious surgery. Hamstring technique has been performedfor most of them under endoscopy before or during the same operativetime as the cartilaginous time. Depending on the size of thelesions, modern techniques were proposed: microfracturing, osteochondralautograft transfer and autologous chondrocytes implantation,they were applied to 8 patients. Nine patients underwent abrasion.With an average follow-up of 36 months, the results could beevaluated according to 3 scores ( Lysholm II, Cincinnati, Tegner) :no worsening was noted and the score was regularly improved comparedwith the preoperative score with 2 excellent results and 19good ones (among which 5 patients treated by hamstring techniqueand autologous chondrocytes implantation) This study allowed topropose the following strategy, mainly based on the size of the cartilaginouslesion : -below 4 cm2 : hamstring technique + microfracturingor osteochondral autograft performed in the same time andunder strict endoscopy ; -above 6 cm2: first, hamstring technique +cartilage biopsy and in a second time, autologous chondrocytesimplantation by arthrotomy with a possibility of inverting the stagesin complex cases. Abrasion is not recommended. As a conclusion,this study plainly confirms the interdependence of the knee struct uresand the necessity to consider, in case of an association of a lesionon anterior cruciate ligament and a condylar cartilage, a strat egytailored to this interdependence to expect a good score, sufficientlystable in time. This strategy is based on three core notions:good axis which is a compulsory prerequisite, ligamentary stabilisationand maximum cartilage repair as early as possible.