Anterior cruciate ligament reconstruction improves activity-induced pain in comparison with pain at rest in middle-aged patients with significant cartilage degeneration.
BACKGROUND
Recent reports revealed that outcomes of anterior cruciate ligament (ACL) reconstruction in middle- or old-age patients are comparable with those of young patients. However, in case of concomitant arthrosis in the affected knee, there has been a paucity of literature regarding the outcomes of ACL reconstruction. We studied the level of improvement in pain originating from significant cartilage degeneration in middle-aged ACL-deficient patients after ACL reconstruction. We divided the pain into pain at rest and activity-induced pain.


OBJECTIVE
The activity-induced pain would be more improved by ACL reconstruction than the pain at rest.


METHODS
Case series; Level of evidence, 4.


METHODS
We studied 36 patients who had undergone arthroscopic isolated ACL reconstruction for functional instability with significant cartilage degeneration grade III or IV without mensical injury. All patients had activity-induced pain; 20 of these patients also had pain at rest. To assess the pain level, the visual analog scale (VAS) was employed, in addition to radiologic and clinical evaluations such as the Lachman test, KT-2000 arthrometer, and pivot shift test. The mean age of the patients was 48.6 years (range, 41-61 years); mean follow-up was 46.7 months (range, 27-74 months).


RESULTS
The preoperative mean VAS of the activity-induced pain (4.1 +/- 1.0; range, 2-6) showed significant improvement at the most recent follow-up (2.0 +/- 1.0; range, 0-4; P < .0001). However, the preoperative mean VAS of the pain at rest (2.9 +/- 0.9; range, 2-5) did not improve significantly at the most recent follow-up (2.5 +/- 0.8; range, 1-4; P = .149). The Lachman test, KT-2000 arthrometer, andpivot shift test showed significant improvement compared with preoperative outcomes (P < .0001). There was no significant difference in radiologic assessment between preoperative and postoperative outcomes (P = .082).


CONCLUSIONS
Anterior cruciate ligament reconstruction in middle-aged patients with significant cartilage degeneration is effective in reducing activity-induced pain and instability. Even though all patients had less than severe arthritic changes on preoperative radiographs, the pain at rest did not improve after ACL reconstruction.
Kim
Sung-Jae
SJ
The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Park
Kwang-Hwan
KH
Kim
Sung-Hoon
SH
Kim
Sul-Gee
SG
Chun
Yong-Min
YM
D000203:Activities of Daily Living; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010003:Osteoarthritis / Q000601:surgery*; D010146:Pain / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012146:Rest; D012189:Retrospective Studies; D016896:Treatment Outcome