Fifteen years after ACL reconstruction, expected survival of the ACL graft was 89% and expected survival of the CACL was 86%. Graft choice did not affect ACL graft rupture, but using BPTB increased the risk of CACL rupture compared with HT. Men had a less favorable survival rate of the ACL graft than did women, and a family history of ACL rupture increased the risk of both ACL graft and CACL rupture.

The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged < 18 years at the time of surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time.ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.Long-term outcomes (> ten years) of endoscopic anterior cruciate ligament (ACL) reconstruction with the bone-patellar tendon-bone (BPTB) graft have been reported, 1,2 but the outcome of endoscopic ACL reconstruction with the hamstring tendon (HT) graft beyond ten years has not.A variety of ACL reconstruction techniques have been shown to be successful in restoring stability to the knee, but questions remain over their role in preventing osteoarthritis (OA). A recent review article has concluded that the available literature is not sufficient to answer this question with certainty. 3Several authors have recorded that the rate of OA is greater in ACL-reconstructed knees than those treated conservatively, [4][5][6] suggesting that the surgery itself might be a cause of degenerative change. It is known that concomitant soft-tissue damage at the time of the initial injury contributes to the development of OA [7][8][9]

At arthroscopy, a frank hemarthrosis was drained. Villous synovitis (Figure 1) was evident in all compartments despite a grossly intact ACL graft (Figure 2). The reported synovial biopsy samples were taken from the suprapatellar pouch. The LARS device was incompletely enshrouded in fibrous tissue with visible fraying (Figure 2