International Orthopaedics

, Volume 35, Issue 4, pp 607–613 | Cite as

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

  • Nikolaus A. Streich
  • David Zimmermann
  • Gerrit Bode
  • Holger Schmitt
Original Article


In this retrospective case series 80 patients divided in 40 matched pair groups with an arthroscopically proven ACL insufficiency were followed up for 15 years. One half was reconstructed using an autologous BTB patella graft, the other half was treated by a conservative physiotherapeutic based rehabilitation program. At follow-up the clinical scores (Lysholm, IKDC) showed no significant differences between subjects who had undergone ACL reconstruction and those who had not. Furthermore there was no detectable difference in the incidence of osteoarthritis between the cohorts. Patients having a negative pivot shift test showed significantly less signs of radiographic osteoarthritis and better functional assessment scores whether reconstructed or not. Based on these results and a review of the literature there is no clear evidence that ACL reconstruction reduces the rate of OA development or improves the long-term symptomatic outcome. Probably review of reconstruction by an anatomical approach will be more successful than operative techniques decades ago.


  1. 1.
    Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8(3):141–150PubMedGoogle Scholar
  2. 2.
    Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86-A(10):2143–2155PubMedGoogle Scholar
  3. 3.
    Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach BR Jr (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31(1):2–11PubMedGoogle Scholar
  4. 4.
    Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22(9):1000–1006PubMedCrossRefGoogle Scholar
  5. 5.
    Linko E, Harilainen A, Malmivaara A, Seitsalo S (2005) Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database Syst Rev 18(2):CD001356Google Scholar
  6. 6.
    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(3):335–346PubMedCrossRefGoogle Scholar
  7. 7.
    Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient a prospective outcome study. Am J Sports Med 22(5):632–644PubMedCrossRefGoogle Scholar
  8. 8.
    Asano H, Muneta T, Ikeda H, Yagishita K, Kurihara Y, Sekiya I (2004) Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients. Arthroscopy 20(5):474–481PubMedCrossRefGoogle Scholar
  9. 9.
    Fink C, Hoser C, Hackl W, Navarro RA, Benedetto KP (2001) (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(4):304–309PubMedCrossRefGoogle Scholar
  10. 10.
    Myklebust G, Holm I, Maehlum S, Engebretsen L, Bahr R (2005) 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(6):981–989Google Scholar
  11. 11.
    Salmon LJ, Russell VJ, Refshauge K, Kader D, Connolly C, Linklater J, Pinczewski LA (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34(5):721–732PubMedCrossRefGoogle Scholar
  12. 12.
    LaValley MP, McAlindon TE, Chaisson CE, Levy D, Felson DT (2001) The validity of different definitions of radiographic worsening for longitudinal studies of knee osteoarthritis. J Clin Epidemiol 54(1):30–39PubMedCrossRefGoogle Scholar
  13. 13.
    Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769PubMedCrossRefGoogle Scholar
  14. 14.
    Kostogiannis I, Ageberg E, Neuman P, Dahlberg L, Fridén T, Roos H (2007) Activity level and subjective knee function 15 years after anterior cruciate ligament injury: a prospective, longitudinal study of nonreconstructed patients. Am J Sports Med 35(7):1135–1143PubMedCrossRefGoogle Scholar
  15. 15.
    Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75(5):594–599PubMedCrossRefGoogle Scholar
  16. 16.
    Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634PubMedCrossRefGoogle Scholar
  17. 17.
    Kubo S, Muratsu H, Yoshiya S, Mizuno K, Kurosaka M (2007) Reliability and usefulness of a new in vivo measurement system of the pivot shift. Clin Orthop Relat Res 454:54–58PubMedCrossRefGoogle Scholar
  18. 18.
    Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15(10):1168–1174PubMedCrossRefGoogle Scholar
  19. 19.
    Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21(11):1323–1329PubMedCrossRefGoogle Scholar
  20. 20.
    Ristanis S, Giakas G, Papageorgiou CD, Moraiti T, Stergiou N, Georgoulis AD (2003) The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc 11(6):360–365PubMedCrossRefGoogle Scholar
  21. 21.
    Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234PubMedCrossRefGoogle Scholar
  22. 22.
    Jakob RP, Staubli HU, Deland JT (1987) Grading the pivot shift. Objective tests with implications for treatment. J Bone Joint Surg Br 69-Br(2):294–299Google Scholar
  23. 23.
    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(5):442–448PubMedCrossRefGoogle Scholar
  24. 24.
    Finsterbush A, Frankl U, Matan Y, Mann G (1990) Secondary damage to the knee after isolated injury of the anterior cruciate ligament. Am J Sports Med 18(5):475–479PubMedCrossRefGoogle Scholar
  25. 25.
    Joseph C, Pathak SS, Aravinda M, Rajan M (2008) Is ACL reconstruction only for athletes? A study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Int Orthop 32(1):57–61PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Nikolaus A. Streich
    • 1
  • David Zimmermann
    • 1
  • Gerrit Bode
    • 2
  • Holger Schmitt
    • 1
  1. 1.Department of Orthopedic Sports MedicineUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Trauma SurgeryUniversity of FreiburgFreiburgGermany

Personalised recommendations