The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up

Abstract

Aim: To evaluate the functional and radiological outcome of a bone-tendon-bone anterior cruciate ligament reconstruction, at long-term follow-up.

Methods: A retrospective study of 148 patients, of which 103 were available for long-term follow-up. Complete functional and radiological evaluation (International Knee Documentation Committee scale) were performed in 89 out of the 103 patients [Anderson AF. Rating scales. In: Fu FH, Harner CD, Vince KG, (Eds.). Knee Surgery, Baltimore, Williams and Wilkins vol. 1, 1994; 12, pp. 275-296].

Results: The mean follow-up time was 17.4 years. Subjectively, 88% of the patients were very satisfied or satisfied. According to the IKDC score 55% had type A symptoms, 29% type B, 12% type C, and 4% type D. The IKDC ligament evaluation showed 14.9% type A, 44.8% type B, 35.8% type C, and 4.5% type D. At the review 22.7% had a narrowing <50% (C) and 4.7% a narrowing >50% (D). Onset of osteoarthritis showed an association with the status of the medial meniscus. Knees with a preserved (healthy or sutured) medial meniscus had a significantly (p < 0.05) better radiological outcome. Among these, 9% had a joint space narrowing <50% (C) and 2% had a narrowing >50% (D). Medial meniscectomy, residual laxity, and femoral chondral defects were associated with osteoarthritis.

Conclusion: The outcome of anterior cruciate ligament reconstruction plus extra-articular tenodesis is good in the very long term, particularly in knees with a preserved medial meniscus.