Purpose to compare the concomitant treatment of the articular cartilage damage (ACD) in the knee with three different articular cartilage procedures at the time of anterior cruciate ligament (ACL) reconstruction.

Methods between the 2006 and 2009, 102 patients with a mean age of 34.1 years and with an ACL rupture and the articular cartilage damage in the knee were randomized to undergo osteochondral autologous transplantation (OAT), microfractures (MF) or debridement (D) at the time of ACL reconstruction. Matched control group was included with 34 patients having intact articular cartilage (IAC) at the time of ACL reconstruction. There were 34 patients in OAT-ACL group, 34 patients in MF-ACL group, 34-D-ACL group and 34-control IAC-ACL group. The mean ACL injury-operation time was 19.32±3.43 months and the mean follow-up was 36.1 months (range from 34 to 37 months). Patients were evaluated using International Knee Documentation Committee (IKDC) score, Tegner activity score and clinical assessment.

Results 97 of 102 (95 %) were available for the final follow-up. According to subjective IKDC score, all 4 groups did significantly better at the 3-year follow up than preoperatively (P<0.0000001). OAT–ACL group IKDC Subjective Knee evaluation was significantly better than MF-ACL (p=0.024) and D-ACL (p=0.018). However, IKDC subjective score of IAC-ACL group was significantly better, than OAT-ACL group IKDC evaluation (p=0.043). There was no significant difference between the MF-ACL and D-ACL IKDC subjective scores (p=0.058). Evaluation of manual pivot-shift knee laxity according to IKDC Knee Examination Form revealed similar evaluations for the four groups immediate postoperative and at 3 year follow-up and was normal or nearly normal (IKDC grade A and B) for 29 of 33 patients (88%) with OAT-ACL, 28 of 32 patients (88%) with MF-ACL, 27 of 32 patients (84%) with D-ACL and 31 of 34 patients (91%) with intact IAC-ACL.

Conclusions Our study shows that intact articular cartilage during ACL reconstruction gives more favourable IKDC subjective scores compared to any other articular cartilage surgery types. However, if you have an articular defect, there are significantly better subjective IKDC scores for OAT versus microfracture or debridement after a mean period of 3 years. Anterior knee stability results were not significantly affected by the different articular cartilage treatment methods.