Skip to main content

Advertisement

SpringerLink
Log in

No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Aim of this study was to record and compare the functional and activity level as well as the manifestations of osteoarthritis after isolated ACL ruptures between patients with conservative treatment and ACL reconstruction with hamstrings tendon graft.

Methods

Thirty-two patients diagnosed with ACL rupture were recorded. Clinical examination included the Tegner and Lysholm activity scale, the International Knee Documentation Committee Subjective Form and KT-1000 arthrometer. Narrowing of the medial and lateral joint spaces was assessed using the IKDC knee examination score.

Results

Median follow-up was 10.3 years (range 10–11). Fifteen patients were conservatively treated (median age 33 years, range 25–39). Seventeen patients were operated (median age 31 years, range 20–36). There was significant difference between the mean values of IKDC scores in favour of the ACL-reconstruction group of patients, 86.8 (SD 6.5) versus 77.5 (SD 13.8), respectively (p = 0.04). The mean value of anteroposterior tibial translation was 1.5 mm (SD 0.2) for ACL-reconstruction group of patients, while the corresponding mean value for ACL-conservative group was 4.5 mm (SD 0.5), p = 0.03. Four patients in ACL-reconstruction group had radiological findings of grade C or D according to IKDC form. In ACL-conservative group, five patients presented similar signs (n.s.).

Conclusions

ACL reconstruction using hamstrings autograft resulted in better functional outcome and laxity measurements than ACL-conservative management. However, the incidence of radiological osteoarthritis was similar between the two groups and independent on the pre-operative grade of laxity and functional status of the patients. Equally, bone bruises were not found as a risk factor for the development of osteoarthritis after ACL rupture.

Level of evidence

Prospective randomized study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ageberg E, Thomee´ R, Neeter C, Silbernagel KG, Roos EM (2008) Muscle strength and functional performance in patients with ACL injury treated with training and surgical reconstruction or training only: a two to five-year follow-up. Arthritis Rheum 59:1773–1779

    Article  PubMed  Google Scholar 

  2. Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘isolated’ anterior cruciate ligament rupture. J Bone Joint Surg Br 94:630–637

    Article  CAS  PubMed  Google Scholar 

  3. Buss DD, Min R, Skyhar M, Galinat B, Warren RF, Wickiewicz TL (1995) Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med 23:160–165

    Article  CAS  PubMed  Google Scholar 

  4. Casteleyn PP, Handelberg F (1996) Non-operative management of anterior cruciate ligament injuries in the general population. J Bone Joint Surg 78-B:446–451

    Google Scholar 

  5. Cohen M, Tarouco Amaro J, Ejnisman B, Carvalho RT, Nakano KK, Peccin MS, Teixeira R, Laurino CF, Abdalla RJ (2007) Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthrosis. Arthroscopy 23:629–634

    Article  PubMed  Google Scholar 

  6. Delay BS, Smolinski RJ, Wind WM, Bowman DS (2001) Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg 14:85–91

    CAS  PubMed  Google Scholar 

  7. Delincé P, Ghafil D (2012) Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature. Knee Surg Sports Traumatol Arthrosc 20:48–61

    Article  PubMed  Google Scholar 

  8. Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27:489–494

    CAS  PubMed  Google Scholar 

  9. Fink C, Hoser C, Hackl W, Navarro RA, Benedetto KP (2001) Long-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture—Is sports activity a determining variable? Int J Sports Med 22:304–309

    Article  CAS  PubMed  Google Scholar 

  10. Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament injured knee. Am J Sports Med 33:335–346

    Article  PubMed  Google Scholar 

  11. Harris K, Driban JB, Sitler MR, Cattano NM, Hootman JM (2014) Five-year clinical outcomes of a randomized trial of anterior cruciate ligament treatment strategies: an evidence-based practice paper. J Athl Train 50:110–112

    Article  PubMed  Google Scholar 

  12. Hart AJ, Buscombe J, Malone A, Dowd GS (2005) Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament: a study using single-photon emission computed tomography at ten years. J Bone Joint Surg Br 87:1483–1487

    Article  CAS  PubMed  Google Scholar 

  13. Hart JM, Turman KA, Diduch DR, Hart JA, Miller MD (2011) Quadriceps muscle activation and radiographic osteoarthritis following ACL revision. Knee Surg Sports Traumatol Arthrosc 19:634–640

    Article  PubMed  Google Scholar 

  14. Hoffelner T, Resch H, Moroder P, Atzwanger J, Wiplinger M, Hitzl W, Tauber M (2012) No increased occurrence of osteoarthritis after anterior cruciate ligament reconstruction after isolated anterior cruciate ligament injury in athletes. Arthroscopy 28:517–525

    Article  PubMed  Google Scholar 

  15. Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA (2011) Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. Am J Sports Med 39:89–98

    Article  PubMed  Google Scholar 

  16. Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS (2008) Function, osteoarthritis and activity after ACL-rupture:11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 16:442–448

    Article  CAS  PubMed  Google Scholar 

  17. Lebel B, Hulet C, Galaud B, Burdin G, Locker B, Vielpeau C (2008) Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft. A minimum 10-year follow-up. Am J Sports Med 36:1275–1282

    Article  PubMed  Google Scholar 

  18. Leys T, Salmon L, Waller A, Linklater J, Pinczewski L (2012) Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med 40:595–605

    Article  PubMed  Google Scholar 

  19. Linko E, Harilainen A, Malmivaara A, Seitsalo S (2005) Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database Syst Rev 2:CD001356

    PubMed  Google Scholar 

  20. Lohmander LS, Atley LM, Pietka TA, Eyre DR (2003) The release of crosslinked peptides from type II collagen into human joint fluid is increased early after joint insult and in osteoarthritis. Arthritis Rheum 48:3130–3139

    Article  CAS  PubMed  Google Scholar 

  21. Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152

    Article  CAS  PubMed  Google Scholar 

  22. Lohmander LS, Roos H (1994) Knee ligament injury, surgery and osteoarthrosis: truth or consequences? Acta Orthop Scand 65:605–609

    Article  CAS  PubMed  Google Scholar 

  23. Luc B, Gribble PA, Pietrosimone BG (2014) Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train 49:806–819

    Article  PubMed  PubMed Central  Google Scholar 

  24. Månsson O, Sernert N, Rostgard-Christensen L, Kartus J (2014) Long-term clinical and radiographic results after delayed anterior cruciate ligament reconstruction in adolescents. Am J Sports Med 43:138–145

    Article  PubMed  Google Scholar 

  25. McAlindon TE, Wilson PWF, Aliabadi P, Weissman B, Felson DT (1999) Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med 106:151–157

    Article  CAS  PubMed  Google Scholar 

  26. Moksnes H, Risberg MA (2009) Performance-based functional evaluation of non-operative and operative treatment after anterior cruciate ligament injury. Scand J Med Sci Sports 19:345–355

    Article  CAS  PubMed  Google Scholar 

  27. Myklebust G, Holm I, Mæhlum S, Engebretsen L, Bahr R (2003) Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury. A follow-up study. Am J Sports Med 31:981–989

    PubMed  Google Scholar 

  28. Nebelung W, Wuschech H (2005) Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes. Arthroscopy 21(696–702):24

    Google Scholar 

  29. Neyret P, Donell ST, Dejour D, Dejour H (1993) Partial meniscectomy and anterior cruciate ligament rupture in soccer players. A study with a minimum 20-year follow-up. Am J Sports Med 21:455–460

    Article  CAS  PubMed  Google Scholar 

  30. Neyret P, Donell ST, Dejour H (1993) Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years. J Bone Joint Surg 75:36–40

    CAS  Google Scholar 

  31. Plaweski S, Petek D, Saragaglia D (2011) Morphometric analysis and functional correlation of tibial and femoral footprints in anatomical and single bundle reconstructions of the anterior cruciate ligament of the knee. Orthop Traumatol Surg Res 97(6 Suppl):S75–S79

    Article  CAS  PubMed  Google Scholar 

  32. Roemer FW, Jarraya M, Niu J, Silva JR, PT RF, Guermazi A (2014) Increased risk for radiographic osteoarthritis features in young active athletes: a cross-sectional matched case-control study. Osteoarthr Cartil. doi:10.1016/j.joca.2014.11.011

    Google Scholar 

  33. Seon JK, Song EK, Park SJ (2006) Osteoarthritis after anterior cruciate ligament reconstruction using a patellar tendon autograft. Int Orthop 30:94–98

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sherman MF, Warren RF, Marshall JL, Savatsky GJ (1988) A clinical and radiographical analysis of 127 anterior cruciate insufficient knees. Clin Orthop Relat Res 227:229–237

    CAS  PubMed  Google Scholar 

  35. Siebold R (2011) The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:699–706

    Article  PubMed  Google Scholar 

  36. Struewer J, Frangen TM, Ishaque B, Bliemel C, Efe T, Ruchholtz S, Ziring E (2012) Knee function and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: long-term follow-up. Int Orthop 36:171–177

    Article  PubMed  Google Scholar 

  37. Von Porat A, Roos EM, Roos HP (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273

    Article  Google Scholar 

  38. Wright RW (2014) Osteoarthritis classification scales: interobserver reliability and arthroscopic correlation. J Bone Joint Surg Am 16(96):1145–1151

    Article  Google Scholar 

  39. Wu WH, Hackett T, Richmond JC (2002) Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med 30:845–850

    PubMed  Google Scholar 

  40. Xie X, Xiao Z, Li Q, Zhu B, Chen J, Chen H, Yang F, Chen Y, Lai Q, Liu X (2014) Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone-patellar tendon-bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years. Eur J Orthop Surg Traumatol 25:149–159

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No benefits have been received in any form by any of the authors with regard to the preparation of this manuscript. All authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Orthopaedic Sports Medicine Clinic, 1-3 Distomou Street, Maroussi, 15125, Athens, Greece

    Dimitrios Tsoukas

  2. Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex, BN2 5BE, UK

    Vasilios Fotopoulos

  3. Academic Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, Greece

    Georgios Basdekis

  4. Flat 155F, Block D, The Plaza, Claypit Lane, Leeds, LS2 8BN, UK

    Konstantinos G. Makridis

  5. Centre Nollet (Teaching center – approved by ESSKA), Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Konstantinos G. Makridis

Authors
  1. Dimitrios Tsoukas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vasilios Fotopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgios Basdekis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos G. Makridis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konstantinos G. Makridis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsoukas, D., Fotopoulos, V., Basdekis, G. et al. No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years. Knee Surg Sports Traumatol Arthrosc 24, 2953–2959 (2016). https://doi.org/10.1007/s00167-015-3593-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3593-9

Keywords

Search

Navigation