Five-Year Clinical and MRI-Based Outcomes After Cartilage Repair With or Without ACL Reconstruction: Worse Clinical Outcome after ACL Reconstruction Does not Affect Cartilage Repair Tissue Quality

ObjectivesCartilage repair (CR) surgery and anterior cruciate ligament reconstruction (ACL-R) are common joint procedures, particularly in younger patients. However, the impact of prior or concurrent ACL-R on the outcomes of CR remains uncertain. This study aimed to evaluate whether ACL-R affects the structural quality and clinical outcomes of CR tissue.MethodsIn this retrospective multicenter study, 71 patients undergoing CR were followed up with magnetic resonance imaging (MRI) and clinical evaluations at 3, 12, and 60 months. Of these, 22 patients underwent ACL-R before or during CR. Morphological assessment was performed using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores; compositional analysis included T2 mapping (<i>n</i> = 45). Patient-reported outcome measures (PROM) were assessed at all time points. Statistical tests included the Mann-Whitney <i>U</i>-test, Wilcoxon signed-rank test, and simulation-based power analysis.ResultsMOCART 2.0 scores and T2 mapping values showed no significant group differences at any time point. Both groups demonstrated significant improvements in PROMs from baseline to 60 months. However, at 60 months, the ACL-R group had significantly lower PROMs than the non-ACL-R group.ConclusionAlthough long-term clinical outcomes were worse in patients with ACL-R, all PROMs improved significantly from baseline to 60 months in both groups. MRI showed no significant differences in focal CR tissue quality, suggesting structural success regardless of ACL-R. While ACL-R patients remain at higher risk of joint degeneration, they can still experience mid-term clinical benefit from CR. These findings support its use in ACL-R patients when joint function is properly restored and expectations are managed.