title: Does anterior cruciate ligament reconstruction lead to degenerative disease?: Thirteen-year results after bone-patellar tendon-bone autograft.
abstract: BACKGROUND
  Reporting of long-term outcome of anterior cruciate ligament (ACL) reconstruction with the patellar tendon (bone-patellar tendon-bone [BTB]) autograft is limited. There are concerns that degenerative joint disease is common in the long term, which may be associated with the procedure itself.
  
  
  OBJECTIVE
  (1) ACL reconstruction with BTB provides good long-term outcome. (2) There are additional factors to surgical reconstruction that can be associated with the development of degenerative disease.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Of 161 patients, 114 were eligible. Patient-centered outcome was by Lysholm and subjective International Knee Documentation Committee (IKDC) score; objective outcome measures were clinical examination and IKDC radiological grade.
  
  
  RESULTS
  Mean average follow-up was 13 years. The IKDC radiological grades in the worst compartment were A = 15%, B = 51%, C = 19%, and D = 14% (n = 83). There was a significant difference between the injured versus contralateral uninjured knee (n = 42, P = .003). In a subgroup with no meniscal or chondral injury the IKDC grades were A = 38%, B = 55%, C = 7%, and D = 0% (n = 29). The mean subjective scores were 89 ± 11 (Lysholm) and 83 ± 15 (IKDC) (n = 114). Poor IKDC subjective outcome was associated with chondral injury (P = .001), previous surgery (P = .022), return to sport (P = .013), and poor radiological grade in the ipsilateral medial compartment (P = .004). A poor IKDC radiological grade was associated with chondral injury (P = .002), meniscal injury (P = .010) and meniscectomy (P = .012), an IKDC subjective score of <85 (P = .01), and poor radiological grade in the contralateral medial compartment (P = .041).
  
  
  CONCLUSIONS
  At 13 years, BTB ACL reconstruction provides a good outcome. Chondral and meniscal damage at surgery were associated with a poor radiological outcome, indicating that injuries sustained during ACL rupture may be the main predictors of degenerative bone disease.
authors: Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom. james.murray@doctors.org.uk
authors: James R D
authors: JR
authors: Murray
authors: Amy M
authors: AM
authors: Lindh
authors: Niall A
authors: NA
authors: Hogan
authors: Alister J
authors: AJ
authors: Trezies
authors: James W
authors: JW
authors: Hutchinson
authors: Erin
authors: E
authors: Parish
authors: John W
authors: JW
authors: Read
authors: Mervyn V
authors: MV
authors: Cross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007718:Knee Injuries / Q000150:complications; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology*; D017847:Patellar Ligament / Q000637:transplantation; D011859:Radiography; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome; D055815:Young Adult