Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up

Am J Sports Med. 2008 Jul;36(7):1275-82. doi: 10.1177/0363546508314721. Epub 2008 Mar 19.

Abstract

Background: Anterior cruciate ligament reconstruction surgery and technique have changed over the past decade.

Hypothesis: Modern arthroscopic management of an anterior cruciate ligament tear using patellar tendon autograft offers a high patient satisfaction rate and good clinical results over the long term. However, it may be associated with osteoarthritis changes over time.

Study design: Case series; Level of evidence, 4.

Methods: In 1992, a prospective computerized database of anterior cruciate ligament reconstruction was established. Since that time, 101 anterior cruciate ligament arthroscopic reconstructions performed at our institution have been observed. Inclusion criteria were as follows: reconstruction with bone-patellar tendon-bone graft, a minimum 10-year follow-up, a standardized operative procedure, and no previous anterior cruciate ligament repair or associated ligament lesions. Before surgery, the mean age of the patients was 28.8 years +/- 8.3 (mean +/- SD). The follow-up assessment was established using the International Knee Documentation Committee (IKDC) 2000 form and quantitative laxity testing with a KT-1000 arthrometer. The joint space narrowing assessment used the IKDC score with a 30 degrees posteroanterior weightbearing view.

Results: Mean follow-up was 11.6 +/- 0.8 years. Nine graft ruptures occurred. The satisfaction rate was excellent (90%). Seventy patients (74%) were still actively participating in sports. The mean subjective IKDC 2000 score was 90.5 +/- 8.8 points. The IKDC score was statistically correlated to laxity, time from injury, and osteoarthritis development at final follow-up. Ninety-one percent of patients were graded A or B according to the overall IKDC score. The radiological assessment reported osteoarthritis development in 17.8% of patients, and 39% showed radiological changes. Osteoarthritis was correlated with body mass index (P = .01) and age at follow-up (P = .006). In a selected population without meniscus and articular cartilage injury, an osteoarthritis rate of only 8% was found. Conclusion Arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft resulted in high patient satisfaction levels and good clinical results after 10 years. Moreover, a high percentage of patients remained involved in sports activities, and anterior cruciate ligament reconstruction protected their meniscus from a secondary tear. However, knee osteoarthritis developed in 17.8% of patients so treated.

MeSH terms

  • Anterior Cruciate Ligament / physiopathology
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries*
  • Arthroscopy* / adverse effects
  • Arthroscopy* / methods
  • Athletic Injuries / diagnostic imaging
  • Athletic Injuries / physiopathology
  • Athletic Injuries / surgery
  • Bone-Patellar Tendon-Bone Grafting / adverse effects*
  • Bone-Patellar Tendon-Bone Grafting / methods*
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Osteoarthritis / etiology*
  • Prospective Studies
  • Radiography