Analysis of Late and Long-Term Outcomes of Surgical Treatment in Patients With Combined Articular Cartilage and Anterior Cruciate Ligament Injuries of the Knee Joint

Objective: To analyze the late (12 months) and long-term (36 months) outcomes of surgical treatment in patients with combined injury of the articular cartilage and anterior cruciate ligament (ACL) of the knee joint. Materials and Methods: A single-center retrospective study was conducted, including 27 patients (16 men, 11 women; median age — 29 years, IQR: 26–33) with combined ACL injury and a single osteochondral defect of one femoral condyle, who underwent treatment at the Department of Traumatology and Orthopedics No. 2, SamSMU Clinics, from 2021 to 2023. All patients underwent ACL reconstruction using semitendinosus and gracilis tendons, as well as mosaic osteochondral autografting of the articular surface of the knee joint. Clinical effectiveness was evaluated using the IKDC-2000 and Lysholm scales, while morphological changes were monitored with MRI, including SNQ index calculation and MOCART scoring. Results: The data demonstrated significant and sustained improvement in the functional status of the knee joint up to 36 months postoperatively: median IKDC-2000 scores increased from 54 to 96, Lysholm scores from 60 to 98, and a decrease in SNQ (from 6.8 to 4.7) indicated the completion of ACL autograft remodeling. High MOCART scores (up to 91 points) reflected successful integration of the osteochondral autograft. Conclusions: Simultaneous mosaic osteochondral autografting and orthobiological ACL reconstruction result in maximal restoration of knee function and stability. This organ-preserving approach leads to significantly better clinical, functional, and morphological outcomes compared to isolated procedures, as evidenced by improvements in IKDC-2000, Lysholm, and MOCART scores, as well as lower SNQ values on postoperative MRI. Comprehensive correction of all injury components effectively prevents instability, reduces the risk of post-traumatic osteoarthritis, and improves patients' quality of life. However, further refinement of techniques, treatment algorithms, and individualized rehabilitation remain important challenges in modern orthopedics.