title: Anterior cruciate ligament (ACL)-deficient knee with degenerative arthrosis: treatment with an isolated autogenous patellar tendon ACL reconstruction.
abstract: We evaluated 58 patients (mean age 30.4 years) who had undergone an isolated anterior cruciate ligament (ACL) reconstruction for chronic instability (mean time from injury to surgery, 8.2 +/- 5.2 years) and showed radiographic evidence of degenerative arthrosis. Objective evaluation at a mean of 4.1 years postoperatively included KT-1000 arthrometer stability, range of motion, and quadriceps muscle strength testing. Subjective analysis at a mean of 5.5 years postoperatively included rating of pain, stability, activity level, and a total score both preoperative and postoperative. Patients were divided into two groups: group 1 (n = 28) with a follow-up < or = 5 years (mean 3.3 years); group 2 (n = 30) with a follow-up > 5 years (mean 7.2 years). Results were analyzed by length of follow-up and by the grade and compartment of arthrosis. All patients enjoyed a full range of motion preoperatively and postoperatively. The mean KT-1000 arthrometer manual maximum difference improved from a mean of 8.2 mm preoperatively to 2.4 mm postoperatively. All subjective scores showed statistically significant improvement over the preoperative values. Patients with medial compartment arthrosis reported a better subjective total score (mean 87) than patients with lateral compartment (mean 73) or bicompartmental (mean 79) arthrosis, but there was not a statistically significant difference. There was no correlation between pain, stability, or total scores and time after surgery. Patients in groups 1 and 2 had equal objective stability and similar subjective scores, but group 2 reported a lower activity level. An isolated ACL reconstruction can provide long-term stability and symptomatic pain relief in patients with chronic instability and arthrosis. The procedure has low morbidity and does not compromise future tibial osteotomy or total knee replacement.
authors.affiliation: Methodist Sports Medicine Center, Indianapolis, IN 46202, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Shelbourne
authors.forename: K C
authors.initials: KC
authors.lastname: Stube
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D010329:Patella; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome