Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes.
OBJECTIVE
The incidence and progression of osteoarthritis over a time period of 35 years following anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly determined. Our study examined this.


METHODS
Retrospective cohort clinical study.


METHODS
Following a central guideline, between March 1963 and December 1965, all 19 athletes in the Olympic program of former East Germany who sustained an ACL injury were treated without reconstruction. In a retrospective cohort study, the clinical results were evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000; 18 of the 19 patients were examined arthroscopically in 1985.


RESULTS
All patients were able to return to sports after a period of 6 to 14 weeks. Ten years after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%). The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%); 20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%). In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had a grade 4 chondral lesion. Ten total knee replacements had to be performed until the end of the year 2000.


CONCLUSIONS
We conclude that, despite the possibility of return to high-level activity with a definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis will occur and patients will have a high risk of becoming a candidate for further total joint replacement.


METHODS
Level IV.
Nebelung
Wolfgang
W
Department of Rheumatology and Arthroscopic Surgery, Marienkrankenhaus Duesseldorf-Kaiserswerth, Duesseldorf, Germany. nebelung@kmr-kliniken.de
Wuschech
Heinz
H
D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D002370:Casts, Surgical; D015331:Cohort Studies; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery*; D007718:Knee Injuries / Q000503:physiopathology* / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D013177:Sports; D013997:Time Factors