Looking Back at Results from ACL SurgeryThere aren't very many long-term studies of results after surgery to repair the anterior cruciate ligament. And many changes have occurred in the last 10 years in the way this procedure is done. In this study, surgeons from France report on 101 knees with an ACL injury. All were repaired with the same bone-patellar tendon-bone (BPTB) arthroscopic graft technique.
In January 1993, they started a computer database of all patients having ACL reconstructions. Data gathered included patient age, time between injury and surgery, and symptoms. Joint laxity (looseness) was measured with a special device called the KT-1000 arthrometer.
X-rays were used to look at joint space and alignment. Function and sports activity were measured with the International Knee Documentation Committee (IKDC) classification tool. And it was recorded whether or not the meniscus (knee cartilage) had been removed.
The authors report about slightly more than half of the patients had a meniscal tear. Most of these were of the medial meniscus on side of the joint closest to the other leg. The longer the time between injury and surgery, the greater the chances for a meniscal tear. In the 11 years after the ACL repair, there were nine knees with a graft rupture. That's about a nine per cent rate of reinjury.
Most of the patients were athletes. About 25 per cent did not return to sports play. The remaining 75 per cent did engage in sports activities. Not as many played contact or pivot sports. But this change wasn't always linked with the surgery. In some cases, there were social and professional factors reported.
Overall, the patients were satisfied with the result of the surgery. The biggest subjective problem was painful kneeling (reported by half the patients). The most significant objective problem was osteoarthritis. Joint changes related to osteoarthritis were seen on X-rays in over one-third of the group. It does appear that ACL reconstruction protects the meniscus from injury. In this study being overweight was a risk factor for osteoarthritis.
The authors conclude that ACL reconstruction using a BPTB graft gives good long-term results. Patients have a nearly normal, stable knee a decade later. The procedure may have a protective effect to prevent further meniscal tears. Normal knee kinematics (movement) was also reported. Degenerative changes in the joint were more likely in older patients with a high body mass index (BMI).
Benoit Lebel, MD, et al. Arthroscopic Reconstruction of the Anterior Cruciate Ligament Using Bone-Patellar Tendon-Bone Autograft. In The American Journal of Sports Medicine. July 2008. Vol. 36. No. 7. Pp. 1275-1282.
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