2015 ISAKOS Biennial Congress ePoster #1388

Long-Term Follow-Up of 20 Years After Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft. A Study of 142 Consecutive Cases

Frédéric Dalat, MD, Aurillac FRANCE
Jean Luc Besse, MD, PhD, Lyon FRANCE
Michel-Henry Fessy, Prof., Lyon FRANCE
Bernard Jl Moyen, MD, Prof., Oullins FRANCE
Centre Hospitalier LyonSud - Hospices Civils de Lyon, Lyon, FRANCE

FDA Status Not Applicable

Summary: At 20 years follow-up, patients with chronic anterior knee laxity who were treated by anatomical single-bundle ACL reconstruction with patellar tendon autograft showed on average good to excellent subjective and objective clinical long-term results with stable knee joints, no specific patellar tendon complications and high satisfaction.

Abstract:

Background

Many studies have reported successful outcomes 10 to 15 years after anterior cruciate ligament (ACL) reconstruction. However, few authors report results at ultra long-term follow-up.

Purpose

The primary aim of our study was to analyse the long-term outcome of patients treated for ACL tears by anatomical single-bundle ACL reconstruction with patellar tendon autograft. The secondary purpose was to identify predictive factors for good outcome and occurrence of osteoarthritis.

Methods

We conducted a retrospective study on a consecutive series of 142 patients operated on between 1992 and 1993. Outcomes measures were conducted by an independent observer. 118 patients (83%) could have a subjective evaluation: International Knee Documentation Committee Subjective Knee Evaluation Form 2000 (IKDC), Tegner Activity Level Scale, Lysholm Knee Score, Knee Injury and Osteoarthritis Outcome score (KOOS). 86 patients (60.6%) had a complete clinical, radiographic and objective laxity evaluation (KT-1000 arthrometer, Lerat dynamic X-Rays). At time of ACL reconstruction, the mean patients age was 25.7±7years (range, 15-47years). The average postoperative follow-up was 242±7months (range, 229-253months).

Results

The total IKDC 2000 was normal in 20 (32%), nearly normal in 29 (46%), abnormal in 12 (19%) and severely abnormal in 3 (5%) of patients. The mean IKDC subjective score was 78.8±13.9 (range, 42.5-100), the KOOS averaged 82.7±15.7 (range, 35-100) and the Lysholm score was 86.5±9.2 (range, 51-100). The Tegner score decreased from pre-injury 8.3 (5-10) to 6 (3-9) at follow-up. The objective IKDC score was as follows: 17.4 % gradeA, 50% gradeB, 30.2% gradeC and 2.3% gradeD. At the last follow-up maxi manual differential KT-1000 averaged 0.97±2.1mm (range, -2mm/7mm). The X-Rays evaluation (according IKDC rating) was normal in 48.8%, benign changes in 19.8%, moderate osteoarthritis 25.6% and severe osteoarthritis in 5.8%. Onset of osteoarthritis was correlated with medial meniscal status, chondral defects at time of surgery and weight gain at the revision. At 20 years follow-up, one-fourth required a reintervention: 9ACL revisions, 19meniscectomies, 2high tibial osteotomy and 1ACL revision with high tibial osteotomy in the same time.

Discussion

Patients with chronic anterior knee laxity who were treated by anatomical single-bundle ACL reconstruction with patellar tendon autograft showed on average good to excellent subjective and objective clinical long-term results with stable knee joints, no specific patellar tendon complication and highly satisfied patients. One-third showed radiological signs of osteoarthritis. Our results are in agreement with those of literature. A short delay between ACL tears and surgery is correlated with good assessment. Medial meniscectomy and articular cartilage damage were risk factors for osteoarthritis. Massive weight gain at the last follow-up is correlated with poor functional outcomes.