HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) An erratum has been published All Versions of this Article: 34/5/721    most recent 0363546505282626v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Salmon, L. J. Articles by Pinczewski, L. A. Search for Related Content PubMed PubMed Citation Articles by Salmon, L. J. Articles by Pinczewski, L. A. Related Collections Reconstruction Graft fixation

Long-term Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft

Minimum 13-Year Review

Lucy J. Salmon, BAppSci(Physio)^*,, Vivianne J. Russell, BSc(Biomed), Kathryn Refshauge, PhD, Deiary Kader, FRCS(Tr&Orth), Chris Connolly, FRCS(Tr&Orth), James Linklater, FRANZCR and Leo A. Pinczewski, FRACS

From the Australian Institute of Musculoskeletal Research, Sydney, Australia, the University of Sydney, Sydney, Australia, and Castlereagh Imaging, Sydney, Australia

^* Address correspondence to Lucy J. Salmon, BAppSci(Physio), Pacific Highway, Crows Nest, Sydney, NSW, Australia 2010 (e-lsalmon{at}nsosmc.com.au).

Background: Short-term results of anterior cruciate ligament reconstruction are well reported; however, there are no studies evaluating endoscopic reconstruction of the anterior cruciate ligament with a minimum 10-year follow-up.

Hypothesis: Anterior cruciate ligament reconstruction with patellar tendon graft affords good subjective results and clinical laxity assessments but may be associated with development of osteoarthritis over the long term.

Study Design: Case series; Level of evidence, 4.

Methods: Endoscopic anterior cruciate ligament reconstruction was performed in 67 consecutive patients without significant articular surface damage. Patients were assessed at 5, 7, and 13 years after surgery with the International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, hop tests, kneeling pain, and radiographs.

Results: At 13-year review, self-reported assessments remained excellent; 96% of patients reported normal or nearly normal knee function. Grade 0 or 1 results were seen in more than 92% of patients on laxity testing. Patients who had undergone meniscectomy at the time of reconstruction had increased laxity between 7 and 13 years on instrumented testing (P = .03) and 6 times greater odds of anterior cruciate ligament graft rupture than if they had not undergone meniscectomy (95% confidence interval, 1–37). Degenerative changes on radiographs were found in 79% of patients at 13 years and were associated with meniscectomy (P = .006), loss of extension (P = .05), and greater laxity on Lachman test (P = .04).

Conclusions: Endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft affords and maintains good self-reported assessments and clinical ligament evaluation up to 13 years. Radiographic degenerative changes were seen in three quarters of patients. Almost half developed loss of extension, suggesting onset of early osteoarthritis. Patients who had undergone meniscectomy at the time of reconstruction had increased clinical ligament laxity over time and greater odds of graft rupture, possibly reflecting the effect of prolonged increased strain on the graft. Continued follow-up is required to resolve concerns regarding integrity of the patellar tendon graft beyond 13 years, particularly in the absence of meniscal tissue.

Key Words: anterior cruciate ligament (ACL) • long term • patellar tendon graft • interference screw fixation

This article has been cited by other articles:

				P. Neuman, M. Englund, I. Kostogiannis, T. Friden, H. Roos, and L. E. Dahlberg Prevalence of Tibiofemoral Osteoarthritis 15 Years After Nonoperative Treatment of Anterior Cruciate Ligament Injury: A Prospective Cohort Study Am. J. Sports Med., September 1, 2008; 36(9): 1717 - 1725. [Abstract] [Full Text] [PDF]

				B. Lebel, C. Hulet, B. Galaud, G. Burdin, B. Locker, and C. Vielpeau Arthroscopic Reconstruction of the Anterior Cruciate Ligament Using Bone-Patellar Tendon-Bone Autograft: A Minimum 10-Year Follow-up Am. J. Sports Med., July 1, 2008; 36(7): 1275 - 1282. [Abstract] [Full Text] [PDF]

				E. Ageberg, A. Pettersson, and T. Friden 15-Year Follow-up of Neuromuscular Function in Patients With Unilateral Nonreconstructed Anterior Cruciate Ligament Injury Initially Treated With Rehabilitation and Activity Modification: A Longitudinal Prospective Study Am. J. Sports Med., December 1, 2007; 35(12): 2109 - 2117. [Abstract] [Full Text] [PDF]

				I. Kostogiannis, E. Ageberg, P. Neuman, L. Dahlberg, T. Friden, and H. Roos Activity Level and Subjective Knee Function 15 Years After Anterior Cruciate Ligament Injury: A Prospective, Longitudinal Study of Nonreconstructed Patients Am. J. Sports Med., July 1, 2007; 35(7): 1135 - 1143. [Abstract] [Full Text] [PDF]

				G. Treme, J. A. Hart, and M. D. Miller What's New in Sports Medicine J. Bone Joint Surg. Am., March 1, 2007; 89(3): 686 - 696. [Full Text] [PDF]

				M. Sajovic, V. Vengust, R. Komadina, R. Tavcar, and K. Skaza A Prospective, Randomized Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: Five-Year Follow-Up Am. J. Sports Med., December 1, 2006; 34(12): 1933 - 1940. [Abstract] [Full Text] [PDF]