Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for "isolated" anterior cruciate ligament tear.
BACKGROUND
Few studies report the long-term results of anterior cruciate ligament rupture and single-incision endoscopic reconstructive surgery. Outcomes are often clouded by concomitant meniscal, chondral, or ligament injuries.


OBJECTIVE
To determine the 15-year outcomes of anterior cruciate ligament ruptures treated with endoscopic anterior cruciate ligament reconstruction using middle-third patellar tendon autograft.


METHODS
Case series; Level of evidence, 4.


METHODS
Between January 1993 and April 1994, 333 consecutive patients underwent anterior cruciate ligament reconstruction. Patients with associated ligamentous injury requiring surgery, previous meniscectomy, or meniscal injury requiring more than one-third meniscectomy; chondral injury diagnosed at arthroscopy; and an abnormal contralateral knee were excluded. Ninety patients met the inclusion criteria. Outcomes included range of motion, Lachman and pivot-shift tests, instrumented ligament testing, single-legged hop test, Lysholm Knee Score, the International Knee Documentation Committee evaluation, and radiographic assessment.


RESULTS
Thirty percent of patients had further anterior cruciate ligament injury. Twenty-four percent of patients (n = 22) sustained contralateral anterior cruciate ligament ruptures, and 8% (n = 7) ruptured the graft (P = .009). Graft rupture was associated with a graft inclination angle <17° (P = .02). Contralateral anterior cruciate ligament rupture was associated with age <18 years at time of primary injury (P = .001). All patients had normal or nearly normal (International Knee Documentation Committee evaluation) Lachman and instrumented testing, and 91% had a negative pivot-shift result. Seventy percent of patients had kneeling pain. Median subjective International Knee Documentation Committee evaluation was 91 of 100. Fifty-one percent of patients had radiographic evidence of osteoarthritis (41% grade B; 10% grade C).


CONCLUSIONS
Good results are maintained at 15 years after surgery with respect to ligamentous stability, subjective outcomes, and range of motion. Kneeling pain remains a significant problem. Concern remains regarding the incidence of further anterior cruciate ligament injury and the increasing number of patients with radiographic and clinical signs of osteoarthritis despite surgical stabilization.
North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia.
Catherine
C
Hui
Lucy J
LJ
Salmon
Alison
A
Kok
Shinichi
S
Maeno
James
J
Linklater
Leo A
LA
Pinczewski
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D056352:Athletes; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods* / Q000534:rehabilitation; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D010146:Pain / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D017847:Patellar Ligament / Q000000981:diagnostic imaging / Q000637:transplantation*; D011859:Radiography; D016059:Range of Motion, Articular; D012421:Rupture / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery; D014182:Transplantation, Autologous / Q000379:methods / Q000534:rehabilitation; D016896:Treatment Outcome; D055815:Young Adult