The long-term course after treatment of acute anterior cruciate ligament ruptures

Abstract

Acute total ACL (N = 60) and concomitant medial collateral ligament (N = 46) ruptures were repaired in 60 patients (mean age, 28 years) without augmentation. Menisci were removed in 23 knees. Fifty-three (88%) of the patients were reexamined 9 to 16 years later with special emphasis on manual and instrumented stability testing (Stryker, Genucom), knee function score (Lysholm), and activity level (Tegner). Standing roentgenograms (30 degrees of knee flexion) were taken in 69% of the patients. At followup, an ACL reconstruction had been performed in seven patients (12%) due to symptomatic instability. Sixty-four percent of the knees had a positive Lachman sign and 40% a positive pivot shift. Sagittal laxity difference was +3 mm or more in 57%. Knee function score was a mean of 86 +/- 12 points. The mean activity level had changed from recreational team sports (Level 7) to recreational individual sports (Level 5). Only patients with good knee stability were able to perform demanding sports and could continue at their desired activity level. Osteoarthritis of slight to moderate degree (Fairbank I/II) was found in 58% of the patients younger than 35 years of age at the time of trauma and in 87% of the older patients. Knees with intact menisci had less osteoarthritis than knees with removed menisci (P less than 0.05).

What are the risk factors in the development of osteoarthritis following ACL reconstruction?

“…However, we found no correlation between instability and OA. Similar conclusions were reached by Sommerlath et al [3] and Gillquist and Messner [2].…”

“…However, we found no correlation between instability and OA. Similar conclusions were reached by Sommerlath et al [3] and Gillquist and Messner [2].Roe et al [4] reported that ACL reconstruction patients with PT autograft showed higher OA incidence than those with hamstring autograft. However in our study we used a patellar tendon autograft in all cases and we have provided no information about the relationship between OA and graf t choice (PT or hamstring).…”

Lesão do ligamento cruzado anterior (LCA) do joelho em população indígena do estado do Amazonas, Brasil

“…The occurrence of repeated sprains resulting from an anterior instability of the knee usually leads to meniscal and chondral injuries. The dissatisfaction of the individuals with their knees' performance motivates surgical treatment to recover stability (3)(4)(5)(6) . However, there is no consensus about the number of patients that will show instability or future degenerative changes.…”

“…The natural progression of this ligament injury remains unclear, but it is believed that the anterior instability may evolve to meniscal and chondral degenerative injuries (3)(4)(5) and the natural evolution is reflected on the performance of these individuals in their physical activities (6) . In the USA, the annual incidence is estimated as 0.35 ACL injury/ general population resident, resulting in approximately 75,000 injuries each year (7) .…”

Hyaluronic acid attenuates osteoarthritis development in the anterior cruciate ligament‐transected knee: Association with excitatory amino acid release in the joint dialysate

“…4 Patients with rupture of the anterior cruciate ligament (ACL) develop posttraumatic OA of the knee. 5 Restoration of knee stability by reconstruction provides symptomatic relief, but does not decrease the incidence of degenerative changes of the ACL injured knee. 6 This suggests that the development of posttraumatic OA may not have a purely biomechanical origin, and that chemical changes may also be involved.…”