We examined 28 young athletes with isolated severe chondral damage in the weight-bearing area of the knee joint clinically and radiographically 14 years after arthroscopic diagnosis. Except for Pridie drilling in 3 cases and occasional cartilage shaving or removal of free bodies, no special treatment was given initially. 21 patients were able to return to preinjury team sport activity levels. During the follow-up period, only 3 patients needed repeat surgery with removal of free bodies, and another 2 underwent diagnostic arthroscopy because of persistent pain. At the latest follow-up evaluation, 22 patients had excellent or good knee function. At this time, the patients were mainly involved in individual sports on a physical fitness level. 12 cases had radiographic joint space reduction (< 50%) which was limited to the compartment concerned.
We retrospectively matched 42 patients with unilateral chondral damage in the weightbearing zone of one knee compartment according to sex, age, location of chondral damage, and follow-up time. Two groups of 21 patients were formed. One group had chondral damage only. The other group had chondral damage and a meniscal tear treated with partial meniscectomy. After 12 to 15 years, all patients were reexamined. Twenty-nine percent (N = 6) of the patients who had a partial meniscectomy needed repeat meniscal surgery during followup. No patients with isolated chondral damage developed meniscal symptoms, and only three patients underwent minor surgeries (P < 0.02). At the follow-up evaluation, both groups had similar knee function with a mean Lysholm score of 87 points. However, most patients had reduced their sports activities from competitive individual sports before injury to noncompetitive physical fitness exercise at followup. At the roentgenologic examination, patients who had partial meniscectomies had more severe roentgenologic signs of osteoarthritis than patients who had chondral damage only (P < 0.03). Meniscectomy, varus knee alignment at the follow-up evaluation (P < 0.04), and age older than 30 years (P < 0.04) at the time of the operation were associated with a higher incidence of osteoarthritis.
A unilateral, complete rupture of the anterior cruciate ligament was diagnosed in 60 consecutive patients by arthroscopy within 1 week of trauma. Most ruptured ligaments were treated by acute nonaugmented repair immediately after the arthroscopy. Fifty-five and 56 patients were reevaluated after 12 years and 20 years, respectively. Twenty-five patients (45%) had at least one reoperation during the follow-up period of 20 years, primarily for meniscal problems. Seven patients (13%) had repeat anterior cruciate ligament surgery. The overall Lysholm knee function score remained at a median of 90 points from 12 to 20 years, but patients had decreased their sporting activities from team sports at full rehabilitation to physical fitness activities at the late follow-up. Patients who had repeat surgery had a worse knee function score, were less satisfied with their knees, and also had to change activities and change work more often than patients without reoperation. The majority of patients had, at both follow-up periods, unstable knees. At 20 years, weightbearing radiographs showed slight-to-moderate changes equivalent to osteoarthrosis in 84% (47) of patients and a 32% increase in osteoarthrosis since the 12-year evaluation.
In this prospective study we investigated 70 patients with chronic anterior instability who underwent anterior cruciate ligament reconstruction with a Dacron prosthesis. Fifty-five (79%) patients could be followed up at a mean of 9 years. Within the follow-up time, 44% (29 of 66) of the prostheses were diagnosed as ruptured; the annual rupture frequency was 5%. Second reconstructions were performed for 20 patients (29%), 5 patients had third reconstructions, and 9 patients wanted no further surgical treatment. Fifty-two patients (74% of the original group) underwent radiographic examination. Eighty-three percent (43) of these patients had radiographic changes in the operated knee, and 40% (21 of 52) had joint space reduction up to 50%. The rate of radiographically detected osteoarthritis was increased 10 times compared with the normal knee. Patients with medical instability and patients older than 30 years at the initial operation had more severe osteoarthritic changes. Based on the functional results of the patients with a ligament in place after 9 years, only 14% (10) of the original group had acceptable stability and knee function.
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