Abstract
PurposeThe aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development.MethodsThe cohort comprised 60 patients with a median follow-up 31 (range 28–33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test.ResultsOut of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001).ConclusionsMedian 31 (range 28–33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts.Level of evidenceRetrospective cohort study, Level III.
Highlights
The anterior cruciate ligament (ACL) is commonly injured with a reported injury rate between 78 and 81 injuries per 100,000 individuals and year [31]
Results of anterior knee laxity using KT-1000 were available for patients with an intact ACL graft and patients with a ruptured ACL graft
A side-to-side laxity difference of ≥ 3 mm was found in 16 patients with a ruptured ACL graft and in seven patients with an intact ACL graft
Summary
The anterior cruciate ligament (ACL) is commonly injured with a reported injury rate between 78 and 81 injuries per 100,000 individuals and year [31]. ACL injury results in an abnormal knee joint laxity due to an increase of anterior translation of the tibia in relation to abnormal elongation and absence of the ACL. This laxity often refers to a feeling of giving way of the knee, due to loss of function of the ACL, leading to pain and varying degrees of disability, ranging from limitations in sports participation to difficulties performing activities of daily living. The prevalence of OA after ACL injuries varies considerably between studies (10–90%), and it has been reported that ACL reconstruction cannot prevent the development of OA [14, 24, 27, 28, 30, 32]. Longterm outcome after an ACL injury is influenced mainly by the presence of associated injuries, such as those of the meniscus and articular cartilage [11, 22, 25, 28, 33]
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