2015 ISAKOS Biennial Congress ePoster #1292

Outcome at 23 Years After ACL Reconstruction with Bone Tendon Bone Autograft

Tiago Martinho, MD, Meyrin, Geneva SWITZERLAND
Philippe Alves, MD, Geneva SWITZERLAND
Daniel Fritschy, MD, Vessy SWITZERLAND
Robin Martin, MD, Lausanne SWITZERLAND

Geneva University Hospital, Geneva, SWITZERLAND

FDA Status Not Applicable

Summary: This long term follow up study shows that menisectomy but not femoral tunnel malposition is associated with increased risk of OA and pain after ALCR. An anterior and proximal position of the femoral tunnel is rather associated with lower KOOS sport component score. At 23 years, less than one sixth of ACLR had failed but almost half of the patients had a remaining for injury recurrence.

Rate:

Abstract:

Purpose

to determine the long term outcome of anterior cruciate ligament reconstruction (ACLR) using bone tendon bone autograft (BTB).

Methods

All patients receiving primary ACL reconstructions with BTB performed between 1984 and 1999 by a single surgeon (DF) were included. Operative reports and clinical charts were retrospectively reviewed. Data from clinical exam and KOOS scores were collected. Up to date knee x-rays were analyzed for osteoarthritic changes (OA) and tunnels positions (according to the method of Bernard et al and Amis et al, for the femoral and tibial tunnel respectively).

Results

146 ACLRs were eligible, 43 lost to follow up. 5 patients were deceased. 98 operated knees were included (88 patients). Mean FU was 23.2±4.4 yrs. Mean age at surgery was 25.5±6.6 yo. Most cases were performed using arthroscopy (n=78; 79.6%). Surgery was performed 1.8±2.4 years after the injury. 21.3% sustained an ACL tear on the opposite knee, at 8.6±5.5 years. 64.9 % of the patients went back to the same level of sport activities. Preoperatively, most patients were involved in IKDC level 1 (65.3%) sports activities. IKDC level 2 was the most frequent (47.9%) at the end of the follow up. Revision surgery occurred in 21.4%, at 11.7±10.1 years, for medial (n=13, 13.2%) or lateral (n=4, 4.1%) menisectomy, revision ACLR (n=3, 3.1%), osteotomy (n=1, 1.0%), and total knee replacement (n=2, 2.0%). ACLR failure rate was 12.8% based on an association of a difference in anterior translation of more than 5 mm at KT1000 exam and a soft end point at the Lachman test. In addition to failed ACLR, 19.1% of the knees had a positive pivot shift test. 42% of the patients with a stable knee on clinical exam described a remaining fear for injury recurrence.
Patients sustaining partial medial or lateral menisectomy (n=30) at time of ACLR had significantly lower KOOS pain component scores than patients with intact meniscus (n=30) (89.6±10.9 vs 96.1±4.7; p=0.007). Their sport component of the KOOS score (73.0±19.0 vs. 78.1±17.8, p=0.3) and total KOOS score (87.8±10.6 vs. 92.2±5.6, p=0.06) had also a tendency to be lower. 92.9 % of knees that sustained medial or lateral menisectomy had some degree of with OA changes in the related compartment (p<0.001).
In patients with intact meniscus at the end of the follow up (n=30), femoral tunnel malposition (anterior and proximal, 16/30) was not associated with increased incidence of OA changes, either in the medial (10/16 vs. 12/14) and lateral compartment (4/16 vs 3/16). Further, we noted no differences in the severity of OA between these groups. Femoral tunnel malposition (n=64) was not associated with increased incidence of revision for menisectomy and revision ACLR (n=17/64 vs. 9/34, p=1). It was associated with a tendency in lower KOOS sport component scores (72.4±18.7 vs. 80.0±20.2, p=0.14) and total KOOS scores (88.7±9.9 vs. 91.1±8.9, p=0.48).

Conclusion

this long term follow up study shows that menisectomy but not femoral tunnel malposition is associated with increased risk of OA and pain after ALCR. An anterior and proximal position of the femoral tunnel is rather associated with lower KOOS sport component score. At 23 years, less than one sixth of ACLR had failed but almost half of the patients had a remaining for injury recurrence.