Long-Term Results of Anterior Cruciate Ligament (ACL) RepairThis is the third follow-up report on a group of patients treated between 1986 and 1988 for anterior cruciate ligament (ACL) rupture. The patients were divided into three groups. Each group had a different method of ACL repair.
The first group had a primary repair using sutures to stitch the torn ligament back together. The second group had an ACL repair just like the first group but with an added feature. The graft repair was reinforced with a braided piece of tendon taken from another muscle. In the past, braided polyethylene was also used. This graft is called a ligament augmentation device. It's inserted to increase the stiffness and strength of the repaired ligament while it's healing.
The third group had an ACL repair with a bone-patellar-tendon-bone graft. The graft is taken from the patellar tendon along the front of the knee. A small piece of attached bone is also used.
The authors compared the results of these three methods of ACL repair at the end of one, five, and 16 years. Level of function, activity, motion, and strength were measured and compared. X-rays were taken to measure the amount of osteoarthritis present.
The results showed that group one (primary repair) had 10 times more re-ruptures and revision surgeries than the other two groups. Only 10 percent of group three (bone-tendon graft) had any joint instability compared with almost half (44 percent) in group one and one-third (29 percent) in group two.
This study confirms the findings of other studies. Simple suture of a torn ACL is not advised. Although the ligament augmentation method had better results than the simple repair, over time the device failed. The knee became unstable. The authors say the best long-term results are obtained with the bone-patellar-tendon-bone graft. No matter what method is used, about 10 percent of the patients had arthritis in that knee.
Jon Olav Drogset, MD, et al. A Sixteen-Year Follow-Up of Three Operative Techniques for the Treatment of Acute Ruptures of the Anterior Cruciate Ligament. In The Journal of Bone and Surgery. May 2006. Vol. 88-A. No. 5. Pp. 944-952.
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