Paper 199: Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen Bone-Patellar-Tendon-Bone Allografts: 15-year Follow-up

Abstract

To evaluate the long-term outcomes following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction using fresh-frozen bone-patellar-tendon-bone (BPTB) allografts. Between 1991 and 1992 38 patients underwent ACL reconstruction using a BPTB allograft by a single surgeon. The same technique was used in all operations, which consisted of the 1-incision endoscopic approach. Of these patients 31 were available for full evaluation. Evaluation included: history, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner score, physical examination, functional knee ligament testing and the International Knee Documentation Committee standard evaluation form (IKDC).Degenerative joint disease on radiographs was scored as prescribed in the x-ray section of the IKDC evaluation form. The average age of the 38 patients at the time of operation was 29.2 (range 13-46) and the mean duration to follow-up was 14.5 years (range 13-16). Three patients were lost to follow-up. 29 reoperations were performed in 17 patients. Reoperations consisted of removal of the fixation material (11 patients), meniscectomy (5 patients), cyclops (2 patients), high tibial osteotomy (2 patients) or revision of the ACL (4 patients, of whom one had a total knee prosthesis afterwards), total knee prosthesis (1 patient and one was expecting one in the near future) and a diagnostic arthroscopy (4 patients). 31 of the 38 patients were available for full examination (3 patients lost to follow-up, 3 patients with a revision surgery and one with a total knee prosthesis). The mean scores for the KOOS subscales were 88.7 for Pain (± 20.7), 79.3 for Symptom (± 20.0), 90.5 for ADL (± 18.5), 72.3 for Sport/Rec (± 32.3) and 75.2 for QOL (±26.2). The mean Tegner score was 4.2 (± 2.2). Using the IKDC evaluation score 3 patients were classified as normal (group A), 11 as nearly normal (group B), 12 as abnormal (group C) and 5 as severely abnormal (group D). 24 patients showed none or mild degenerative joint disease (group A and B). 2 patients showed moderate (group C) and 5 patients severe (group D) degenerative joint disease. Only 14 patients (45.2%) were classified as normal or nearly normal using the IKDC evaluation score. More than half of the patients (54.8%) required one or more re-operations and 7 patients (22.6%) showed moderate or severe degenerative joint disease.