Abstract
Main indication for ACL-reconstruction is to prevent joint instability and thereby the development of osteoarthritis. Nevertheless malfunction and osteoarthritis is frequently seen after ACL-reconstruction. The development of osteoarthritis and the functional outcome after non-operative treatment compared to ACL-reconstruction was analyzed in this long term study. 94 patients (47 matched pairs, 60m, 34f, 13-54ys, Ø 32ys) were arthroscopically diagnosed to have an isolated ACL-rupture and matched in two groups (bone-ligament-bone-transplant OP vs. non– operative treatment NOP). With a mean follow-up of 11.4 years all patients were examined clinically, radiologically and evaluated with internationally accepted scores (Tegner, IKDC). X-rays were taken and the degree of osteoarthritis was classified according to Kellgren and Lawrence. IKDC: NOP (in %) vs. OP (in %) A (normal): 15 vs. 51 B (nearly normal): 42 vs. 17 C (abnormal): 29 vs. 23 D (severely abnormal): 14 vs. 9 Postoperative function (IKDC) showed significant better results for ACL-reconstruction (p<0.05). Radiology: NOP (in %) vs. Op (in%): Grade 0 (no significant changes) 58 vs. 47 Grade I (minute osteophyte) 17 vs. 11 Grade II (definite osteophyte) 21 vs. 38 Grade III (dimunition joint) 4 vs. 4 Grade IV (joint space impaired) 0 vs. 0 Significant more osteoarthritis (Grade II or more in the Kellgren & Lawrence System) was seen after ACL-reconstruction. Tegener-Score: NOP (in Ø) vs. OP (in Ø) pre-injury: 5.7 vs. 5.7 post-injury: 5.1 vs. 4.9 Tegner-Score showed no significant difference (p=0.16) Eleven years after ACL-rupture no significant difference was seen in the activity level. A significant difference was detectable in postoperative function expressed as IKDC with higher level after ACL-reconstruction. Definite osteoarthritis (Grade 2 or more) was verified in 42% after ACL-reconstruction compared to 25% with conservative treatment. ACL-Reconstruction did improve function and stability but does not prevent osteoarthritis in the long term.
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