[Evaluation of cartilage changes within the scope of second-look arthroscopy 12 months after surgical reconstruction of anterior cruciate ligament rupture].
The anterior cruciate ligament (ACL) rupture is among the most frequent injuries of the joints. Actually, there is no doubt regarding the necessity for surgical treatment. However, little is known about the progression of osteochondral damages and their distribution following reconstruction of the ACL. We treated 150 tears of the ACL either acute (median 7d) with augmented reinsertion (n = 41) and with autologous bone patella tendon graft (n = 24) or chronic (median 369d) with autologous bone patella tendon graft (n = 85). The study design was prospective. All osteochondral defects were documented in the six compartments. Second look arthroscopy and clinical examination were performed after twelve months in the course of removal of implants and possible changes of the osteochondral state were evaluated. Detoriation of osteochondral state was seen in 86 (57%) of 150 patients, while there was no statistical difference between the three groups. The time of operation had no influence on the osteochondral damage. There was a significant increase of chondral damages in the medial and retropatellar compartment after autologous bone patella tendon graft, while the changes after augmented reinsertion were diffuse. There were no significant differences in the clinical examination between the three groups regarding the Lysholm score and the functional and subjective outcome. However, postoperative instability was frequently observed (positive pivot-shift 25%, positive Lachmann test 57%). We suggest that postoperative instability should have led to the increased osteochondral damages.
Krischak
G
G
Abteilung Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Steinhövelstrasse 9, 89075 Ulm. gert.krischak@medizin.uni-ulm.de
Hömig
D
D
Beck
A
A
Wachter
N
N
Pokar
S
S
Kinzl
L
L
Hehl
G
G
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012086:Reoperation; D012307:Risk Factors; D013709:Tendon Transfer / Q000379:methods