Very long-term osteoarthritis rate after anterior cruciate ligament reconstruction: 182 cases with 22-year’ follow-up

Curado, Jonathan; Hulet, Christophe; Hardy, P.; Jenny, Jean–Yves; Rousseau, Romain; Lucet, Antoine; Steltzlen, Camille; Morin, Vincent; Grimaud, Olivier; Bouguennec, Nicolas; Pujol, Nicolas; Sonnery‐Cottet, Bertrand; Graveleau, Nicolas

doi:10.1016/j.otsr.2019.09.034

Cited by 59 publications

(49 citation statements)

References 21 publications

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“…25,44 Previous studies have assessed the incidence of OA after ACL reconstruction using HT and BPTB at 10- to 15-year follow-up and noted an incidence of OA between 21% and 51%. 9,21,25 Outcomes of ACL reconstruction at minimum 20-year follow-up have been assessed by several studies 7,8,10,35,37,38,40,42 ; however, these studies used BPTB grafts or a combined intra- and extra-articular reconstruction, and studies investigating the long-term outcomes of HT graft ACL reconstruction are lacking. One study assessed the long-term (20-year) outcomes of HT graft ACL reconstruction using femoral screw fixation, 35 but no studies have investigated the 20-year outcomes of HT graft reconstruction with femoral cortical button fixation.…”

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confidence: 99%

Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up

et al. 2020

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Background: The short-term outcomes of anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone or hamstring tendon (HT) graft are excellent with good clinical stability and patient-reported outcomes. Although some studies have reported the long-term outcomes of bone–patellar tendon–bone graft ACL reconstruction, few have reported the outcomes of HT graft ACL reconstruction. Purpose: To assess clinical and radiographic outcomes of HT graft ACL reconstruction with femoral cortical button fixation at a minimum 20-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A prospective study was performed in which all patients undergoing isolated transtibial primary ACL reconstruction between 1994 and 1996 with HT graft and femoral cortical button fixation were assessed clinically and radiographically. Follow-up was obtained in 48 of 94 patients (51%). Median (interquartile range) age at operation was 31 years (26-39 years); median follow-up was 21 years (20-22 years); 65% were male; and 48% had meniscal injury at surgery and underwent partial meniscectomy. Graft rupture, reoperation, and contralateral injury rates were assessed; clinical stability was measured using the KT-1000 arthrometer; patient-reported outcomes were assessed (International Knee Documentation Committee [IKDC], Lysholm, Forgotten Joint Score, Tegner activity, Knee injury and Osteoarthritis Outcome Score [KOOS], Anterior Cruciate Ligament Quality of Life [ACL-QOL], EuroQol 5-Dimension 5-Level [EQ-5D-5L]); and radiographic osteoarthritis (defined as Kellgren-Lawrence grade ≥2) was assessed for the ipsilateral and the contralateral knee. Results: Graft rupture occurred in 4 patients (8%), contralateral injury in 4 patients (8%), and reoperation in 15 patients (31%), which consisted mainly of meniscal tears or hardware removal. In patients with an intact graft, excellent patient-reported outcome measures (PROMs) were noted, with a median Lysholm of 90 (78-100), subjective IKDC of 86 (72-95), and KOOS–Sports of 86 (58-100). There was low awareness of the operated knee (Forgotten Joint Score, 81 [60-96]) and good quality of life (ACL-QOL, 85 [75-94]; EQ-5D-5L, 0.87 [0.83-1.00]). Median side-to-side difference, as measured with the KT-1000 arthrometer, was 1 mm (-1 to 3 mm). Radiographic osteoarthritis was evident in 49% of ipsilateral and 10% of contralateral knees and was associated with meniscectomy at index surgery and decreased PROMs at follow-up. Conclusion: Long-term outcomes of transtibial HT graft ACL reconstruction with femoral cortical button fixation are generally good with a low failure rate, low awareness of the operated knee, and good clinical stability. Radiographic osteoarthritis was evident in approximately half of the patients at 20-year follow-up and was associated with meniscectomy at index surgery and decreased PROMs at follow-up.

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confidence: 99%

Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up

et al. 2020

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“…A further 6 studies were prospective case series, 17 , 19 , 26 – 28 , 37 and 5 studies were retrospective case series. 9 , 10 , 20 , 23 , 36 The 74 patients who received hamstring tendon grafts in the comparative study by Thompson et al 31 were excluded from the analysis because they were already accounted for in another study from the same authors evaluating 200 ACLRs with hamstring tendons 27 ; however, data from Thompson et al 31 were used if not available in the complete series. The characteristics of the included studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The mean subjective IKDC score (9 studies ‡ ; 1140 patients) was 78.6, whereas the mean Lysholm score (9 studies § ; 503 patients) was 89.3 ( Figure 2 ). The mean KOOS scores (8 studies 9 – 11 , 23 , 26 , 28 , 33 , 37 ; 674 patients) were 89.4 for the Pain subscale, 76.8 for the Symptoms subscale, 94.8 for the Activities of Daily Living subscale, 76.6 for the Sport subscale, and 75.3 for the Quality of Life subscale. The mean Tegner score (8 studies ∥ ; 437 patients) was 4.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Outcomes and Osteoarthritis at Very Long-term Follow-up After ACL Reconstruction: A Systematic Review and Meta-analysis

Grassi

Pizza

Al-zu’bi

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Few studies on outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have provided insight into the very long-term effects of this procedure. Purpose: To systematically review the outcomes, failure rate, incidence, and predictors of osteoarthritis (OA) for different ACLR techniques at a minimum 20-year follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, SCOPUS, and Cochrane databases was performed on June 2020 for studies of patients who underwent ACLR and had a minimum follow-up of 20 years. We extracted data on patient and surgical characteristics, patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee [IKDC] score, Knee injury and Osteoarthritis Outcome Score [KOOS], and Tegner score), clinical outcomes (IKDC grade, pivot shift, Lachman, and KT-1000 laxity), degree of OA (Kellgren-Lawrence, Ahlbäck, and IKDC OA grading), revisions, and failures. Relative risk (RR) of OA between the operated and contralateral knees was calculated as well as the pooled rate of revisions, failures, and conversion to total knee arthroplasty (TKA). Results: Included were 16 studies (N = 1771 patients; mean age, 24.8 years; mean follow-up, 22.7 years); 80% of the patients underwent single-bundle bone–patellar tendon–bone (BPTB) reconstruction. The average Lysholm (89.3), IKDC (78.6), and KOOS subscale scores were considered satisfactory. Overall, 33% of patients had “abnormal” or “severely abnormal” objective IKDC grade, 6.7% had KT-1000 laxity difference of ≥5 mm, 9.4% had Lachman ≥2+, and 6.4% had pivot shift ≥2+. Signs of OA were reported in 73.3% of patients, whereas severe OA was reported in 12.8%. The operated knee had a relative OA risk of 2.8 ( P < .001) versus the contralateral knee. Identified risk factors for long-term OA were male sex, older age at surgery, delayed ACLR, meniscal or cartilage injuries, BPTB autograft, lateral plasty, nonideal tunnel placement, residual laxity, higher postoperative activity, and postoperative range of motion deficits. Overall, 7.9% of patients underwent revision, and 13.4% of ACLRs were considered failures. TKA was performed in 1.1% of patients. Conclusion: Most patients had satisfactory subjective outcomes 20 years after ACLR; however, abnormal anteroposterior or rotatory laxity was found in nearly 10% of cases. The presence of radiographic OA was high (RR 2.8 vs uninjured knee), especially in patients with concomitant meniscal or cartilage injuries, older age, and delayed surgery; however, severe OA was present in only 12.8% of cases, and TKA was required in only 1.1%.

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“…Episodes of giving way due to anterior knee instability could result in meniscal tears and degeneration of the articular cartilage [ 4 ]. Curado et al demonstrated that moderate to severe knee OA affects 29 % of ACL deficient patients during a period of 22 years [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature

Mortazavi

Noori

Vosoughi

et al. 2021

BMC Musculoskelet Disord

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Background Anterior cruciate ligament (ACL) injury may be associated with genu varum. There are a few indications in which the varus deformity can be corrected at the time of ACL reconstruction. However, as the genu varum originates mostly from the tibia and the simultaneous presence of ACL deficiency and femur originated genu varum is uncommon, only a few papers have described their management for ACL deficient patients with femur originated genu varum. Case presentation A young patient visited our clinic with a complaint of right knee pain and giving way. Further work up revealed a full mid substance ACL tear, mild medial knee osteoarthritis and femur originated genu varum of his right knee. He was managed with simultaneous ACL reconstruction and distal femoral valgus osteotomy. Conclusions Any corrective osteotomy for genu varum should be performed at center of rotation angle. Isolated ACL reconstruction in patients with simultaneous ACL deficiency and genu varum may hasten the knee degeneration. Level of evidence IV

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Very long-term osteoarthritis rate after anterior cruciate ligament reconstruction: 182 cases with 22-year’ follow-up

Cited by 59 publications

References 21 publications

Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up

Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up

Clinical Outcomes and Osteoarthritis at Very Long-term Follow-up After ACL Reconstruction: A Systematic Review and Meta-analysis

Femur originated genu varum in a patient with symptomatic ACL deficiency: a case report and review of literature

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