Patellar tendon autografts for anterior cruciate ligament reconstruction

Foto: iStock.com/Wavebreakmedia

To date, there is a lack of data on radiographic and physical results more than 20 years after anterior cruciate ligament (ACL) reconstruction, say researchers at the Shelbourne Knee Center in Indiana (US). The hypothesis investigated in the present study was that the risk of osteoarthritis (OA) at > 20 years after surgery would be statistically significantly higher if certain factors were present.

In total, 1,428 knees were included that met the following inclusion criteria: primary ACL surgery, no existing OA or other ligamentous laxity, and no known graft tear. The authors determined the effect of potential predictors on the odds of having radiographic evidence of OA with the help of multivariate and univariate logistic models, and conducted subjective surveys (International Knee Documentation Committee, IKDC, and Cincinnati Knee Rating System (CKRS).

423 knees were followed up for a minimum of 20-year after the surgery. Radiographic ratings were normal for 35.2 %, nearly normal for 36.2 %, abnormal for 20.1 %, and severely abnormal for 8.5 % of patients. The predictive factors for the presence of OA in the long-term were i) medial meniscectomy, ii) older age at surgery, and iii) less than normal knee extension at discharge. The odds ratios for statistically significant factors for the presence of any OA at follow-up were 2.02 for knee extension loss at discharge, 2.98 for medial meniscectomy, 1.65 for lateral meniscectomy, 1.06 for age at follow-up, 1.62 for chronic injury type, and 2.17 for articular cartilage damage. The IKDC and CKRS subjective scores were progressively and statistically significantly lower as the level of OA increased.

In this cohort, 28.6 % of patients developed moderate to severe OA at > 20 years after ACL reconstruction. Significant predictive factors for OA in the long-term were older age at surgery, medial meniscectomy, and knee extension loss.

Source: Shelbourne, K. D. et al.: "Results of Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts: Objective Factors Associated With the Development of Osteoarthritis at 20 to 33 Years After Surgery", The American Journal of Sports Medicine, 2017 Oct;45(12):2730-2738, https://doi.org/10.1177/0363546517718827. 

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