Original Article
Long-Term Results of Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone: An Analysis of the Factors Affecting the Development of Osteoarthritis

https://doi.org/10.1016/j.arthro.2011.12.019Get rights and content

Purpose

To evaluate the clinical outcomes and incidence of knee osteoarthritis (OA) and the factors associated with the onset of OA in the 3 compartments of the knee joint separately after anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone autograft.

Methods

Clinical and radiologic assessments were obtained from 117 patients (80.1%). At follow-up, knee function was evaluated with the Lysholm score, Hospital for Special Surgery (HSS) score, Tegner score, and International Knee Documentation Committee (IKDC) 2000 forms. We also evaluated stability and donor-site morbidity. On the follow-up radiographs, OA was assessed by IKDC grading. The factors affecting the onset of OA in the 3 compartments of the knee joint were evaluated.

Results

The mean follow-up period was 10.3 ± 1.0 years. The mean Lysholm and HSS scores significantly increased at final follow-up (P < .001). The mean IKDC subjective score was 90.6, and 93.9% of patients had grade A or grade B knees on the objective evaluation. The mean side-to-side difference measured by KT-2000 arthrometer (MEDmetric, San Diego, CA) was 1.6 ± 1.7 mm, with 82.0% of patients showing a difference of less than 3 mm. Discomfort from knee walking on hard ground and skin numbness were reported by 38.4% and 37.6% of patients, respectively. OA developed in the medial, lateral, and patellofemoral compartments in 30.7%, 9.3%, and 7.6% of patients, respectively. The onset of OA was associated with partial meniscectomy (odds ratio [OR], 20.73; P = .005) or sagittal tibial tunnel position (OR, 1.18; P = .02) in the medial compartment and body mass index (BMI) (OR, 1.56; P = .02) in the lateral compartment.

Conclusions

ACL reconstruction with bone–patellar tendon–bone autograft showed satisfactory clinical results after a mean of 10.3 years. However, pain when walking on hard ground (38.4%) and numbness of the skin (37.6%) were reported. Moreover, the onset of OA appeared in over 40% of the patients. The onset of OA in the medial compartment was correlated with partial meniscectomy and sagittal tibial tunnel position, and the onset of OA in the lateral compartment was correlated with higher BMI.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Participants and Preoperative Demographics

Between March 1997 and September 2001, 191 consecutive arthroscopic ACL reconstructions using BPTB autograft were performed at our institute. We excluded 45 of these patients because of either an associated ligament injury requiring surgery, prior knee surgery including meniscectomy, or bilateral ACL injuries. The inclusion criterion was primary ACL reconstruction using BPTB autograft with or without meniscal injury. Of the 146 patients included, 117 (80.1%) returned for clinical and radiologic

Clinical Evaluation

The mean preoperative Lysholm and HSS scores were 72.5 ± 12.5 (range, 27 to 90) and 78.1 ± 12.2 (range, 27 to 91), respectively. The mean postoperative Lysholm and HSS scores were 88.5 ± 7.6 (range, 65 to 100) and 87.4 ± 5.0 (range, 63 to 100), respectively. There was a significant increase in Lysholm score (P < .001) and HSS score (P < .001) at final follow-up. At follow-up, the mean IKDC 2000 subjective score and the mean Tegner score were 90.6 ± 10.3 (range, 51 to 100) and 6.2 ± 1.2 (range,

Discussion

This article reports the long-term clinical results of ACL reconstruction using BPTB autograft with particular attention to the development of knee OA. An analysis of the factors that might contribute to the progression of knee OA in the medial, lateral, and patellofemoral compartments separately by use of multiple logistic regression is also provided. Keays et al.12 evaluated the factors involved in the development of OA of the tibiofemoral joint and patellofemoral joint separately at 6 years

Conclusions

Arthroscopic ACL reconstruction with BPTB autograft showed satisfactory clinical results after a mean of 10.3 years. However, pain when walking on hard ground (38.4%) and numbness of the skin (37.6%) were reported. Moreover, the onset of OA appeared in over 40% of the patients. The onset of OA in the medial compartment was correlated with partial meniscectomy and sagittal tibial tunnel position, and the onset of OA in the lateral compartment was correlated with higher BMI.

References (36)

  • B. Lebel et al.

    Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: A minimum 10-year follow-up

    Am J Sports Med

    (2008)
  • B.E. Øiestad et al.

    Knee osteoarthritis after anterior cruciate ligament injury: A systematic review

    Am J Sports Med

    (2009)
  • A. Meunier et al.

    Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: A randomized study with a 15-year follow-up

    Scand J Med Sci Sports

    (2007)
  • C.D. Harner et al.

    Anterior and posterior cruciate ligament reconstruction in the new millennium: A global perspective

    Knee Surg Sports Traumatol Arthrosc

    (2001)
  • L.J. Salmon et al.

    Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: Minimum 13-year review

    Am J Sports Med

    (2006)
  • P. Hertel et al.

    ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-Year clinical results

    Knee Surg Sports Traumatol Arthrosc

    (2005)
  • W.H. Wu et al.

    Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: A long-term prospective study

    Am J Sports Med

    (2002)
  • M.A. Kessler et al.

    Function, osteoarthritis and activity after ACL-rupture: 11 Years follow-up results of conservative versus reconstructive treatment

    Knee Surg Sports Traumatol Arthrosc

    (2008)
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      Additionally, a chondral lesion of Outerbridge classification grade II or worse in the medial tibio-femoral joint was reported to be an obvious risk factor for knee OA after ACL reconstruction [201]. Since consistent knee instability due to ACL insufficiency leads to knee OA, it is highly possible to reduce the risk of knee OA by ACL reconstruction, especially for ACL-injured knees with concomitant meniscal tears [103,202–223]. In the guideline committee meeting, 1 committee member (14.3%) advocated “recommendation” of ACL reconstruction and 6 members (85.7%) supported the “suggestion” for this CQ.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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