{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:05:41Z","timestamp":1789491941694,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To evaluate return\u2010to\u2010play rate, timing, and performance level at 5\u2009years after primary anterior cruciate ligament (ACL) reconstruction in patients with concomitant chondral lesions and to determine whether lesion severity, location, or coexisting meniscal pathology influenced these outcomes. Secondarily, ipsilateral and contralateral ACL reinjury rate and patient\u2010reported outcomes were reported.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients who underwent primary ACL reconstruction with an arthroscopically confirmed chondral lesion were included and followed up for 5\u2009years. Exclusion criteria were the absence of chondral injury, the need for concurrent repair or reconstruction of knee ligaments other than the ACL, and an age outside the specified range (13\u201045\u2009years). Lesion severity was graded using the International Cartilage Repair Society system. Chondral lesions were left in situ or underwent chondroplasty or microfracture. Return\u2010to\u2010play (RTP) rate, RTP timing, performance level, incidence of ACL reinjury, and patient\u2010reported outcomes were compared by chondral lesion severity and location. The patient\u2010reported outcomes used were the Marx Activity Rating Scale score, Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, and the Western Ontario and McMaster Universities Osteoarthritis Index. Between\u2010group comparisons were performed using\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n (categorical) and Mann\u2010Whitney U or Kruskal\u2010Wallis (continuous) tests. Multivariable Cox regression and ordinal regression analyzed independent predictors of RTP and patient\u2010reported outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 441 patients were included at a minimum of 5\u2010year (mean 61\u2009months, range 60\u201072\u2009months) follow\u2010up. The mean age at surgery was 26.8\u2009\u00b1\u20097.6\u2009years, and 78% (346\/441) of patients were male. At 5 years, 83% (348\/419) of patients had returned to play, with no statistically significant difference in RTP rates between grade 1 to 2 and grade 3 to 4 lesions in either the medial (85% (102\/120) vs 77.4% (55\/71),\n P<\/jats:italic>\n \u2009=\u2009.179) or lateral compartments (85.1% (149\/175) vs 86.6% (13\/15),\n P<\/jats:italic>\n \u2009=\u2009.850). The mean time from surgery to RTP was 13.9\u2009\u00b1\u20098\u2009months, and this did not differ by lesion severity (grade 1\u20102 vs grade 3\u20104) in any compartment. At 5\u2009years, there was no difference in performance level (achieving the same\/higher) between those with medial, lateral, and patellofemoral chondral injuries (medial 57.4% (101\/176) vs lateral 64.7% (101\/156) vs patellofemoral joint 69.0% (9\/29),\n P<\/jats:italic>\n \u2009=\u2009.268). Contralateral injury rates were lower for patients with grade 3 to 4 lesions (4.2%, 3\/71) of the medial compartment compared with grade 1 to 2 (12.9%, 27\/210,\n P<\/jats:italic>\n \u2009<\u2009.033). The mean Marx score declined across all knee compartments at 5\u2009years postoperatively although there was no difference in the mean reduction between each compartment (\n P<\/jats:italic>\n \u2009=\u2009.845). In the medial compartment, grade 1 to 2 lesions had an average International Knee Documentation Committee score of 85.0\u2009\u00b1\u200912.9, whereas grade 3 to 4 lesions scored 81.0\u2009\u00b1\u200914.4 (\n P<\/jats:italic>\n \u2009<\u2009.020). Similarly, in the lateral compartment, grade 1 to 2 lesions averaged 86.9\u2009\u00b1\u200911.7, compared with 80.9\u2009\u00b1\u200915.8 in grade 3 to 4 lesions (\n P<\/jats:italic>\n \u2009<\u2009.049). Increasing age was associated with worse International Knee Documentation Committee scores (odds ratio: 0.94, 95% confidence interval: 0.91\u20100.97,\n P<\/jats:italic>\n \u2009<\u2009.001) and worse Western Ontario and McMaster Universities Osteoarthritis Index total scores (odds ratio: 1.1, 95% confidence interval: 1.01\u20101.09,\n P<\/jats:italic>\n \u2009<\u2009.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Chondral lesion severity and location did not determine RTP rate, performance, or postoperative activity levels. Combined high\u2010grade medial chondral pathology with medial meniscal involvement and increasing age predicted worse patient\u2010reported outcomes. These findings support counselling athletes that RTP is achievable despite focal chondral damage.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level IV, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70567","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T16:31:03Z","timestamp":1789489863000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chondral Lesion Severity and Location Are Not Associated With Return\u2010to\u2010Play Outcomes After Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9713-9057","authenticated-orcid":false,"given":"Timothy","family":"McAleese","sequence":"first","affiliation":[{"name":"RCSI University of Medicine and Health Sciences Dublin Ireland"},{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Okoli","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran A.","family":"Moran","sequence":"additional","affiliation":[{"name":"Department of Sport Science and Nutrition Maynooth University Maynooth Ireland"},{"name":"Insight Research Ireland Centre for Data Analytics Dublin City University Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jackson","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Withers","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Moran","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2947-6996","authenticated-orcid":false,"given":"Brian M.","family":"Devitt","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic Santry, Dublin Ireland"},{"name":"School of Health and Human Performance Dublin City University Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.arthro.2009.09.002","article-title":"Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: Incidence and treatment","volume":"26","author":"Brophy RH","year":"2010","journal-title":"Arthroscopy."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2106\/JBJS.K.00905","article-title":"Comparison of community\u2010based ACL reconstruction registries in the U.S. and Norway","volume":"3","author":"Maletis GB","year":"2011","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.2106\/00004623-200300002-00008","article-title":"Evaluation of cartilage injuries and repair","volume":"85","author":"Brittberg M","year":"2003","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1302\/0301-620X.43B4.752","article-title":"The etiology of chondromalacia patellae","volume":"43","author":"Outerbridge RE","year":"1961","journal-title":"J Bone Joint Surg Br."},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1177\/03635465211028247","article-title":"articular cartilage and meniscus predictors of patient\u2010reported outcomes 10 years after anterior cruciate ligament reconstruction: A multicenter cohort study","volume":"49","author":"Brophy RH","year":"2021","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s00167-019-05739-1","article-title":"Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury","volume":"28","author":"Everhart JS","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s00402-008-0786-4","article-title":"Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old","volume":"129","author":"Ichiba A","year":"2009","journal-title":"Arch Orthop Trauma Surg."},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1177\/0363546509350914","article-title":"Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery","volume":"38","author":"Keays SL","year":"2010","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/0363546511428580","article-title":"Does anterior cruciate ligament reconstruction lead to degenerative disease?: Thirteen\u2010year results after bone\u2010patellar tendon\u2010bone autograft","volume":"40","author":"Murray JRD","year":"2012","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1177\/0363546514525910","article-title":"Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6\u2010year multicenter cohort study","volume":"42","author":"Cox CL","year":"2014","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1177\/0363546510370280","article-title":"Predictors of activity Level 2 years after anterior cruciate ligament reconstruction (ACLR): A multicenter orthopaedic outcomes network (MOON) ACLR cohort study","volume":"38","author":"Dunn WR","year":"2010","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1177\/0363546517749850","article-title":"Ten\u2010year outcomes and risk factors after anterior cruciate ligament reconstruction: A MOON longitudinal prospective cohort study","volume":"46","author":"MOON Knee Group","year":"2018","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1016\/j.joca.2015.05.025","article-title":"KOOS pain as a marker for significant knee pain 2 and 6 years after primary ACL reconstruction: A multicenter orthopaedic outcomes network (MOON) prospective longitudinal cohort study","volume":"23","author":"Wasserstein D","year":"2015","journal-title":"Osteoarthritis Cartilage."},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.1177\/0363546518788325","article-title":"Ten\u2010year risk factors for inferior knee injury and osteoarthritis outcome score after anterior cruciate ligament reconstruction: A study of 874 patients from the swedish national knee ligament register","volume":"46","author":"Hamrin Senorski E","year":"2018","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1007\/s00167-011-1739-y","article-title":"Patients with focal full\u2010thickness cartilage lesions benefit less from ACL reconstruction at 2\u20105 years follow\u2010up","volume":"20","author":"R\u00f8tterud JH","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/0363546512473571","article-title":"Effect of meniscal and focal cartilage lesions on patient\u2010reported outcome after anterior cruciate ligament reconstruction: A nationwide cohort study from norway and sweden of 8476 patients with 2\u2010year follow\u2010up","volume":"41","author":"R\u00f8tterud JH","year":"2013","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"232596711878621","DOI":"10.1177\/2325967118786219","article-title":"Effect of concomitant cartilage lesions on patient\u2010reported outcomes after anterior cruciate ligament reconstruction: A nationwide cohort study from norway and sweden of 8470 patients with 5\u2010year follow\u2010up","volume":"6","author":"Ulstein S","year":"2018","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.2106\/00004623-200300002-00002","article-title":"Outcome of untreated traumatic articular cartilage defects of the knee: A natural history study","volume":"85","author":"Shelbourne KD","year":"2003","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1007\/s00167-021-06757-8","article-title":"Concomitant full\u2010thickness cartilage lesions do not affect patient\u2010reported outcomes at minimum 10\u2010year follow\u2010up after ACL reconstruction","volume":"30","author":"Wang K","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1177\/0363546508328104","article-title":"Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: Results at 10\u2010 and 15\u2010year follow\u2010up","volume":"37","author":"Widuchowski W","year":"2009","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"3061","DOI":"10.1007\/s00167-016-4097-y","article-title":"Do cartilage lesions affect the clinical outcome of anterior cruciate ligament reconstruction? A systematic review","volume":"25","author":"Filardo G","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1136\/bjsports-2016-096278","article-title":"2016 consensus statement on return to sport from the first world congress in sports physical therapy, Bern","volume":"50","author":"Ardern CL","year":"2016","journal-title":"Br J Sports Med."},{"key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1177\/03635465010290051301","article-title":"Development and validation of the international knee documentation committee subjective knee form","volume":"29","author":"Irrgang JJ","year":"2001","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_25_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1177\/03635465010290021601","article-title":"Development and evaluation of an activity rating scale for disorders of the knee","volume":"29","author":"Marx RG","year":"2001","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2519\/jospt.1998.28.2.88","article-title":"Knee injury and osteoarthritis outcome score (KOOS)\u2010\u2010development of a self\u2010administered outcome measure","volume":"28","author":"Roos EM","year":"1998","journal-title":"J Orthop Sports Phys Ther."},{"key":"e_1_2_8_27_1","first-page":"1833","article-title":"Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy N","year":"1988","journal-title":"J Rheumatol."},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"2820","DOI":"10.1177\/0363546516652888","article-title":"Defining thresholds for the patient acceptable symptom state for the IKDC subjective knee form and KOOS for patients who underwent acl reconstruction","volume":"44","author":"Muller B","year":"2016","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1136\/bjsm.2010.076364","article-title":"Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta\u2010analysis of the state of play","volume":"45","author":"Ardern CL","year":"2011","journal-title":"Br J Sports Med."},{"key":"e_1_2_8_30_1","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1177\/03635465241313386","article-title":"Primary anterior cruciate ligament reconstruction in Level 1 athletes: Factors associated with return to play, reinjury, and knee function at 5 years of follow\u2010up","volume":"53","author":"McAleese T","year":"2025","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s00167-021-06558-z","article-title":"Return to preinjury sports after anterior cruciate ligament reconstruction is predicted by 5 independent factors","volume":"30","author":"Muller B","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_32_1","doi-asserted-by":"crossref","first-page":"3762","DOI":"10.1177\/03635465221127297","article-title":"Rates and levels of elite sport participation at 5 years after revision ACL reconstruction","volume":"50","author":"Pinheiro VH","year":"2022","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_33_1","doi-asserted-by":"crossref","first-page":"2514","DOI":"10.1007\/s00167-014-3023-4","article-title":"Factors associated with returning to football after anterior cruciate ligament reconstruction","volume":"23","author":"Sandon A","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1016\/j.arthro.2017.11.019","article-title":"Patients with concomitant intra\u2010articular lesions at index surgery deteriorate in their knee injury and osteoarthritis outcome score in the long term more than patients with isolated anterior cruciate ligament rupture: A study from the swedish national anterior cruciate ligament register","volume":"34","author":"Balasingam S","year":"2018","journal-title":"Arthroscopy."},{"key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1177\/03635465231172769","article-title":"Predictors of return to activity at 2 years after anterior cruciate ligament reconstruction among patients with high preinjury marx activity scores: A MOON prospective cohort study","volume":"51","author":"MOON Knee Group","year":"2023","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_36_1","doi-asserted-by":"crossref","first-page":"232596712513913","DOI":"10.1177\/23259671251391362","article-title":"Return to sport and risk of second anterior cruciate ligament (ACL) injury in elite male footballers: 10\u2010year experience from a single center","volume":"13","author":"Grassi A","year":"2025","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_37_1","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1177\/03635465251350398","article-title":"Effect of focal cartilage lesions on patient\u2010reported outcomes after anterior cruciate ligament reconstruction: A 10\u2010year nationwide cohort study of 7040 patients","volume":"53","author":"Kjennvold S","year":"2025","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_38_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1177\/03635465211060333","article-title":"Patient\u2010reported outcome, return to sport, and revision rates 7\u20109 years after anterior cruciate ligament reconstruction: Results from a cohort of 2042 patients","volume":"50","author":"Randsborg PH","year":"2022","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_39_1","doi-asserted-by":"crossref","first-page":"232596711775418","DOI":"10.1177\/2325967117754189","article-title":"Influence of meniscal and chondral lesions on patient\u2010reported outcomes after primary anterior cruciate ligament reconstruction at 2\u2010year follow\u2010up","volume":"6","author":"Cinque ME","year":"2018","journal-title":"Orthop J Sports Med."}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70567","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/arj.70567","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/arj.70567","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T16:31:08Z","timestamp":1789489868000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/arj.70567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":38,"alternative-id":["10.1002\/arj.70567"],"URL":"https:\/\/doi.org\/10.1002\/arj.70567","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"assertion":[{"value":"2026-01-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"arj.70567"}}