Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft With and Without a Ligament Augmentation Device: A 25-Year Follow-up of a Prospective Randomized Controlled Trial

Abstract

Background:Various grafts and ligament augmentation devices (LADs) have been used in the search for optimal reconstruction of the anterior cruciate ligament (ACL).Purpose:To compare 25-year follow-up results after ACL reconstruction using a bone–patellar tendon–bone (BPTB) graft with or without the Kennedy LAD.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:One hundred patients undergoing ACL reconstruction between 1991 and 1993 were randomized into 2 groups: reconstruction using a BPTB graft alone (BPTB group, 51 patients) or a BPTB graft with the Kennedy LAD (LAD group, 49 patients). The 25-year follow-up evaluation included a clinical knee examination, patient-reported outcome measures, and an assessment of radiological osteoarthritis (OA) according to the Ahlbäck classification. Additional outcomes were reruptures and knee arthroplasty.Results:Ninety-three patients (93%) were available for the follow-up evaluation: 48 patients in the BPTB group and 45 in the LAD group. Through telephone calls, 26 patients were excluded from further investigation because of reruptures and arthroplasty in the knee of interest; 67 patients were further investigated. A total of 43 of 44 (98%) and 42 of 44 (95%) patients had negative or 1+ Lachman and pivot-shift test results, respectively. The mean Lysholm score was 85 for the BPTB group and 83 for the LAD group. All mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values were ≥73. There were no statistically significant differences between groups in any of these outcomes or regarding the Tegner score, radiological classification of OA, or number of ACL reruptures. Signs of radiological OA were detected in all patients, and severe radiological OA (Ahlbäck grade III, IV, or V) was detected in 32% of patients in the BPTB group and 21% of patients in the LAD group (P = .37). There were 12 patients in the BPTB group and 7 in the LAD group who had documented reruptures (P = .40). One patient in the BPTB group and 6 in the LAD group underwent knee arthroplasty (P = .054).Conclusion:In the present study, there were no statistically significant differences between groups in any of the outcomes. After 25 years, 19% of patients had reruptures, 27% had severe radiological OA, and 7% underwent knee arthroplasty.

The long-term outcomes of different grafts in anterior cruciate ligament reconstruction: a network meta-analysis

“…We further screened these studies and excluded unmatched group dividing studies, studies with no available or relative data, studies with incomplete data, studies with short-term follow-up and other studies needed to be excluded according to the search strategy. Finally, 30 studies were included [ 12 , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [75] , [76] , [77] , [78] , [79] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , 92 ].

Figure 1 Summary of search process with PRISMA.

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Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up

“…25,44 Previous studies have assessed the incidence of OA after ACL reconstruction using HT and BPTB at 10- to 15-year follow-up and noted an incidence of OA between 21% and 51%. 9,21,25 Outcomes of ACL reconstruction at minimum 20-year follow-up have been assessed by several studies 7,8,10,35,37,38,40,42 ; however, these studies used BPTB grafts or a combined intra- and extra-articular reconstruction, and studies investigating the long-term outcomes of HT graft ACL reconstruction are lacking. One study assessed the long-term (20-year) outcomes of HT graft ACL reconstruction using femoral screw fixation, 35 but no studies have investigated the 20-year outcomes of HT graft reconstruction with femoral cortical button fixation.…”

Patellar tendon versus artificial grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis

“…From the search of the three online databases, a total of 748 studies were identified, and 426 eligible studies were screened after duplicates were excluded. Two studies were of the same patients with different follow-up times [ 23 , 24 ], and we included the most recent study. Seven studies [ 24 – 30 ] met the predetermined inclusion criteria.…”

“…Two studies were of the same patients with different follow-up times [ 23 , 24 ], and we included the most recent study. Seven studies [ 24 – 30 ] met the predetermined inclusion criteria. All studies compared bone-patellar tendon-bone (BPTB) grafts with artificial grafts, and no studies evaluating other autografts were identified.…”