Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment

Abstract

ACL-reconstruction aims to restore joint stability and prevent osteoarthritis; however, malfunction and osteoarthritis are often the sequelae. Our study asks whether ACL-reconstruction or conservative treatment lead to better long-term results. In this retrospective cohort study, 136 patients with isolated ACL-rupture who had been treated by bone-ligament-bone transplant or conservatively were identified. Twenty-seven of these were excluded because of a revision operation in the 11.1 years follow-up period, leaving 109 patients (60 reconstructions and 49 conservatively treated) for evaluation based on clinical, radiological and internationally accepted knee-scores (Tegner, IKDC, Kellgren and Lawrence). An individual cohort study is classified as EBM level 2b according to the Oxford Centre of EBM. We observed significantly better knee-stability (P = 0.008) but more osteoarthritis (Grade II or higher) after ACL-reconstruction (42% vs. 25%). Physical activity levels were similar in both groups during the follow-up period (P = 0.16). Eleven years after ACL-rupture the physical activity levels are similar for both groups. After ACL-reconstruction, stability is higher as is osteoarthritis, whereby the result is not necessarily perceived as better subjectively. Specifically, this retrospective study yielded a 24% incidence of oseoarthrits 11 years after conservative management of ACL-rupture in patients not needing secondary surgery. The risk of secondary meniscal tears is reduced after ACL reconstruction, which reduces the negative effects of OA after surgery. The ultimate objective would be to achieve a good subjective outcome by conservative treatment followed by a rehabilitation program designed to keep secondary meniscus tears at a low level.

Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up

“…On the contrary, a study by Daniel et al showed a trend towards a greater prevalence of osteoarthritis in surgically-treated than in non-surgically treated patients [7]. Also Kessler et al reported on a significantly higher rate of osteoarthritis in patients 11 years following an operative treatment of ACL insufficiency [23]. In contrast to our investigation they excluded patients with meniscal injuries or chondral lesions, which rarely occur [24].…”

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

“…10 Many grafts function as mechanical springs that span the gap between the femur and tibia, providing stability and allowing joint motion, but do not complete the ligamentization process or restore the original biomechanics to the knee even 2-3 years after surgery. [8][9][10] In addition, the incidence of early-onset OA within 7-14 years after knee injury is as high as 50%, 5,11,12 without improved outcomes as a result of ACL reconstruction. 5,13 Thus, there is a need for a ligament graft that will develop biochemically relevant and biomechanically compatible interfaces with native tissue and restore the proper biomechanics and physiological function to the ligament.…”

Knee Frontal-Plane Biomechanics in Adults With or Without Bone Marrow Edema-Like Lesions After Anterior Cruciate Ligament Injury

“…In fact, Butler et al 12 tested participants an average of 5 years postoperatively, a time when radiographic osteoarthritis may be influencing lower extremity biomechanics. [24][25][26] When comparing KAM in the ACL þ BB and control groups with the ACL-injury group, we observed strong effect sizes with CIs that did not cross zero. These large effect sizes suggest that participants may have had clinically relevant differences in KAM.…”