Analysis of risk factors for knee cartilage damage in patients with anterior cruciate ligament rupture

This retrospective study evaluated risk factors for concomitant cartilage damage in patients with anterior cruciate ligament (ACL) rupture treated between 1 January 2021 and 31 December 2024. Eligible adults (18-60 years) had ACL rupture confirmed by magnetic resonance imaging (MRI) and/or arthroscopy and complete clinical, imaging, and intraoperative data. Patients were stratified into a cartilage damage group (n = 61) and a non-damage group (n = 89). Demographic and injury-related variables were compared, and multivariable logistic regression identified independent associations; diagnostic performance was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC). Age and sex were comparable between groups. Cartilage damage was associated with higher body mass index (BMI), more sprain episodes, longer injury-to-evaluation time, and markedly higher rates of meniscal injury. In adjusted analyses, BMI > 22.9 kg/m² (odds ratio [OR] 1.13; 95% confidence interval [CI] 1.02-1.25), meniscal injury (OR 1.65; 95% CI 1.16-2.36), >1 sprain (OR 1.56; 95% CI 1.14-2.14), and time > 16 days (OR 1.75; 95% CI 1.12-2.74) were independently associated with cartilage damage. ROC analysis showed good discrimination for time since injury (AUC 0.893; optimal cutoff > 16.4 days) and number of sprains (AUC 0.889; operationally ≥ 2), whereas BMI provided modest discrimination (AUC 0.629). These findings support risk-stratified early imaging, timely stabilization with meniscal management, and load-reduction strategies to mitigate structural progression.