Treatment of unstable chronic anterior cruciate ligament-deficient knee with osteoarthritis

Abstract

Untreated ruptures of anterior cruciate ligament (ACL) lead to progressive meniscus tear and development of knee osteoarthritis over decades. The present study was designed to explore the early results of ACL reconstruction for the patients with unstable ACL-deficient knee with osteoarthritis. Twelve patients with a mean age of 46 years (range: 35 - 54) underwent ACL reconstruction for ACL-deficient knee with osteoarthritis. All had chronic anterior instability and one or more episodes of knee instability. There was no previous diagnosis of ACL ruptures and no prior ligament surgery on involved knee. The preoperative duration of symptoms was 1 to 5 years. ACL reconstruction with arthroscopic single-bundle four-strand hamstring tendon autograft was performed for all patients. The laxity of knee was determined with Lachman and pivot tests. The patient subjective evaluation of function was examined with the modified Lysholm scoring scale pre- and post-operatively. Obvious articular cartilage degeneration and cartilage space stenosis in medial compartment were found in 9 patients and complex medial meniscus tear in 10. During the follow-up period of 9 - 36 months, there was no graft failure or loss of ROM (range of motion) for any of these knees. The symptoms of instability were relieved in all patients. The post-operative knee stability improved markedly. The modified Lysholm scores improved from a median pre-operative score of 62.0 points to an average of 89.5 at the last follow-up. ACL reconstruction with hamstring tendon may significantly relieve symptoms and improve knee functions in the patients of chronic anterior cruciate ligament-deficient knee with osteoarthritis, especially in those with primary symptoms of instability.