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Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years

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Abstract

Purpose

The aim of this study was to evaluate patient-reported clinical outcome, instrumental stability and prevalence of radiological osteoarthritis (OA) based on a homogeneous patient sample after two years and on average ten years after isolated anterior cruciate ligament (ACL) reconstruction.

Methods

Primarily we performed ACL reconstruction using a four-strand semitendinosus tendon (ST) autograft in 112 patients. Two years after reconstruction 98 patients could be re-evaluated. Long-term clinical and functional follow-up assessment was then performed on 52 patients on average 10.2 years after operative treatment. Inclusion criteria consisted of an isolated ACL rupture, reconstruction with ST graft and no associated cartilage alterations and meniscal lesions. Clinical and functional follow-up assessment included the International Knee Documentation Committee (IKDC) score and the scores of Tegner and Lysholm. Instrumental stability testing was carried out with the KT1000™ arthrometer. The degree of degenerative changes and prevalence of OA was based on the Jäger-Wirth score.

Results

The mean long-term follow-up was 10.2 years (eight–13 years), and the mean age was 40.4 years (24–62 years). About 72 % of patients were graded A or B according to the IKDC score. Activity levels according to the scores of Tegner and Lysholm were 4.8 and 88.2 on long-term follow-up. Radiological assessment revealed degenerative changes in the sense of a grade I OA in 21.2 % of patients. Prevalence of a grade II OA was found in 53.8 % of patients. A grade III OA and a grade IV OA were found in 19.2 and 5.7 %. Correlation analysis showed significant relationships between the long-term stability and prevalence of OA (p < 0.05).

Conclusions

Arthroscopic ACL reconstruction using four-strand ST autograft resulted in high patient satisfaction and good clinical results at two years and long-term follow-up. The prevalence of higher degree OA that developed in about 25 % of patients is significantly correlated with long-term knee joint stability.

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References

  1. Andersson D, Samuelsson K, Karlsson J (2009) Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy 25(6):653–685

    Article  PubMed  Google Scholar 

  2. Herrington L, Fowler E (2006) A systematic literature review to investigate if we identify those patients who can cope with anterior cruciate ligament deficiency. Knee 13(4):260–265

    Article  PubMed  Google Scholar 

  3. Gobbi A, Francisco R (2006) Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc 14(10):1021–1028

    Article  PubMed  Google Scholar 

  4. Mihelic R, Jurdana H, Jotanovic Z, Madjarevic T, Tudor A (2011) Long-term results of anterior cruciate ligament reconstruction: a comparison with non-operative treatment with a follow-up of 17–20 years. Int Orthop 35(7):1093–1097

    Article  PubMed  Google Scholar 

  5. Louboutin H, Debarge R, Richou J, Selmi TA, Donell ST, Neyret P, Dubrana F (2009) Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee 16(4):239–244

    Article  PubMed  Google Scholar 

  6. Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxén E, Karlsson J (2005) Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 21(8):958–964

    Article  PubMed  Google Scholar 

  7. Poolman RW, Abouali JA, Conter HJ, Bhandari M (2007) Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: why are they different? J Bone Joint Surg Am 89(7):1542–1552

    Article  PubMed  Google Scholar 

  8. van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(9 Suppl):S2–S12

    PubMed  Google Scholar 

  9. Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Röpke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478

    Article  PubMed  Google Scholar 

  10. Fox JA, Nedeff DD, Bach BR Jr, Spindler KP (2002) Anterior cruciate ligament reconstruction with patellar autograft tendon. Clin Orthop Relat Res 402:53–63

    Article  PubMed  Google Scholar 

  11. Herrington L, Wrapson C, Matthews M, Matthews H (2005) Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee 12(1):41–50

    Article  PubMed  Google Scholar 

  12. Lidén M, Sernert N, Rostgård-Christensen L, Kartus C, Ejerhed L (2008) Osteoarthritic changes after anterior cruciate ligament reconstruction using bone-patellar tendon-bone or hamstring tendon autografts: a retrospective, 7-year radiographic and clinical follow-up study. Arthroscopy 24(8):899–908

    Article  PubMed  Google Scholar 

  13. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33(9):1337–1345

    Article  PubMed  Google Scholar 

  14. Fithian DC, Paxton LW, Goltz DH (2002) Fate of the anterior cruciate ligament-injured knee. Orthop Clin North Am 33(4):621–636

    Article  PubMed  Google Scholar 

  15. Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463

    Article  PubMed  Google Scholar 

  16. Levy AS, Meier SW (2003) Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin North Am 34(1):149–167

    Article  PubMed  Google Scholar 

  17. Shelbourne KD, Benner RW (2009) Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries. J Knee Surg 22(3):187–190

    Article  PubMed  Google Scholar 

  18. 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):1756–1769

    Article  PubMed  Google Scholar 

  19. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 38(8):1542–1548

    Article  PubMed  Google Scholar 

  20. 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(6):845–850

    PubMed  Google Scholar 

  21. 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(4):517–525

    Article  PubMed  Google Scholar 

  22. 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(7):1275–1282

    Article  PubMed  Google Scholar 

  23. Möller E, Weidenhielm L, Werner S (2009) Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc 17(7):786–794

    Article  PubMed  Google Scholar 

  24. Øiestad BE, Engebretsen L, Storheim K, Risberg MA (2009) Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 37(7):1434–1443

    Article  PubMed  Google Scholar 

  25. Øiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38(11):2201–2210

    Article  PubMed  Google Scholar 

  26. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35(4):564–574

    Article  PubMed  Google Scholar 

  27. 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(1):171–177

    Article  PubMed  Google Scholar 

  28. Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ, International Knee Documentation Committee (2006) The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 34(1):128–135

    Article  PubMed  Google Scholar 

  29. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154

    Article  PubMed  CAS  Google Scholar 

  30. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198(198):43–49

    PubMed  Google Scholar 

  31. Tyler TF, McHugh MP, Gleim GW, Nicholas SJ (1999) Association of KT-1000 measurements with clinical tests of knee stability 1 year following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 29(9):540–545

    PubMed  CAS  Google Scholar 

  32. Jäger M, Wirth C (1986) Praxis der Orthopaedie. Thieme, Stuttgart, p 980

    Google Scholar 

  33. 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):442–448

    Article  PubMed  CAS  Google Scholar 

  34. 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(3):595–605

    Article  PubMed  Google Scholar 

  35. Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38(3):448–454

    Article  PubMed  Google Scholar 

  36. Mascarenhas R, Tranovich MJ, Kropf EJ, Fu FH, Harner CD (2012) Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2–10 year follow-up. Knee Surg Sports Traumatol Arthrosc 20(8):1520–1527

    Article  PubMed  Google Scholar 

  37. Schiphof D, Boers M, Bierma-Zeinstra SM (2008) Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 67(7):1034–1036

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany

    Johannes Struewer & Turgay Efe

  2. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Marburg, Germany

    Ewgeni Ziring, Thomas M. Frangen, Benjamin Buecking & Christopher Bliemel

  3. Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen, Giessen, Germany

    Steffen Meißner & Bernd Ishaque

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  1. Johannes Struewer
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  2. Ewgeni Ziring
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  3. Thomas M. Frangen
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  4. Turgay Efe
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Correspondence to Johannes Struewer.

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Struewer, J., Ziring, E., Frangen, T.M. et al. Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years. International Orthopaedics (SICOT) 37, 271–277 (2013). https://doi.org/10.1007/s00264-012-1653-z

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  • DOI: https://doi.org/10.1007/s00264-012-1653-z

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