Paper 201: The Prevention of Post-operative Arthrosis Following ACL Reconstruction Is Possible if Osseous Homeostasis is Restored and Maintained

Abstract

Recent reports from the USA, Europe, and Asia have documented the disconcerting phenomenon of early knee arthrosis following even biomechanically well done ACL reconstructive surgery. In prior work, we have suggested that the achievement of a normal Tc 99-MDP bone scan - representing an objective marker of the restoration of osseous/joint homeostasis – following ACL reconstructive (and other) knee surgery is predictive of the absence of DJD out to 7 years. In this work, we report on 19 patients with 20 ACL reconstructed knees followed to between 10 to 15 years postoperatively both radiographically and scintigraphically. 19 patients (14 males and 5 females with a mean age of 28 - range 18 to 43 -at the time of single bundle BTB autograft reconstruction by SFD) with 20 reconstructed knees are included in this report. In addition to a history and physical examination, all patients had a Rosenberg X-ray and a standard 3 hr delayed static Tc 99MDP bone scan of the knees between 10 and 15 (mean 12.8) years post reconstruction. 18/20 knees demonstrated a normal or nearly normal Rosenberg X-ray and bone scan of the involved knee. Two of the 20 knees demonstrated a positive bone scan associated with radiographic signs of degenerative arthrosis (joint space narrowing and osteophyte formation). The degree of post-operative laxity did not correlate with the absence of degenerative changes. In prior work, we have shown that persistent loss of osseous homeostasis (manifested by positive bone scans) identifies knees “at risk” of developing early arthritis. In this work we have demonstrated in a population of ACL reconstructed knees using a single-bundle BTB autograft technique - the principle that if osseous/joint homeostasis can be restored and maintained (currently best documented by normal bone scans) such knees can remain free of degenerative changes out to a mean of 12.8 years post-operatively. For those who may wish to avoid irreversible degenerative arthrosis in ACL reconstructed knees, it is recommended that the achievement of osseous/ joint homeostasis become a clinical priority.