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

Abstract

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.

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

“…In contrast to their report and other previously published investigations the mean Lysholm score was lower in both of our treatment cohorts. While Salmon et al [11] showed good to excellent Lysholm knee scores in 80% of their patients, with a mean score of 89 points after 13 years of follow-up undergoing endoscopic ACL reconstruction, the present Lysholm mean was 68 points for our ACL reconstructed patients.…”

“…Kostogiannis et al [14] reported good functional scores in their conservatively-treated patients at the 15 year follow-up. As a large number of studies have reported on clinical assessment after ACL insufficiency but only few extend beyond ten years of follow-up [13], we can just speculate on a potential influence of time as there is certain evidence of a significant deterioration of the clinical scores over time [11,12]. Interestingly, the self-reported activity level graded according to Tegner had a mean of 4 for ACL and 5 for non-ACL and was therefore higher than in comparable studies [11,12].…”

“…One of the main reasons for ligament reconstruction is to avoid a degenerative destruction of the joint cartilage. Even though degeneration of the joint increases over longer periods of time [11], investigations reporting the long-term results of ACL reconstructions are rare. Therefore the purpose of this retrospective study was to investigate the outcome of the ACL-injured patient treated by reconstruction with a patellar tendon autograft respectively undergoing a conservative physiotherapy-based rehabilitation program after a follow-up of 15 years.…”

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

“…Long-term studies have reported a high incidence of joint degeneration (as much as 52% to 56% 12 to 13 years after surgery) [36,42] and an estimated 8% to 10% of ACL reconstructions result in recurrent instability and graft failure [18,23,51]. Furthermore, studies have suggested that the ability of current reconstruction techniques to prevent degenerative changes compared with nonoperative treatment is limited [11,[13][14][15]36].…”

Use of a bioscaffold to improve healing of a patellar tendon defect after graft harvest for ACL reconstruction: A study in rabbits

“…[5][6][7][8][9][10] Furthermore, recent long-term data following reconstruction with a PT autograft showed osteoarthritic changes in 79% of patients. 11 It is also well known that the biomechanical properties of the healing PT are substantially inferior when compared to normal tissues. [12][13][14][15] Therefore, there is a need to enhance the healing of the PT while limiting the fat pad adhesion in some patients to help to improve the function of the healing PT and restore the normal extensor mechanism of the knee following ACL reconstruction.…”