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.
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.
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.
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).
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.
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.