Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes

Arthroscopy. 2005 Jun;21(6):696-702. doi: 10.1016/j.arthro.2005.03.010.


Purpose: The incidence and progression of osteoarthritis over a time period of 35 years following anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly determined. Our study examined this.

Type of study: Retrospective cohort clinical study.

Methods: Following a central guideline, between March 1963 and December 1965, all 19 athletes in the Olympic program of former East Germany who sustained an ACL injury were treated without reconstruction. In a retrospective cohort study, the clinical results were evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000; 18 of the 19 patients were examined arthroscopically in 1985.

Results: All patients were able to return to sports after a period of 6 to 14 weeks. Ten years after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%). The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%); 20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%). In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had a grade 4 chondral lesion. Ten total knee replacements had to be performed until the end of the year 2000.

Conclusions: We conclude that, despite the possibility of return to high-level activity with a definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis will occur and patients will have a high risk of becoming a candidate for further total joint replacement.

Level of evidence: Level IV.

MeSH terms

  • Anterior Cruciate Ligament / pathology
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Casts, Surgical
  • Cohort Studies
  • Follow-Up Studies
  • Germany
  • Humans
  • Joint Instability / physiopathology*
  • Joint Instability / surgery*
  • Knee Injuries / physiopathology*
  • Knee Injuries / surgery
  • Patient Selection
  • Retrospective Studies
  • Sports*
  • Time Factors