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Anterior cruciate ligament reconstruction with hamstring tendons and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors

Anterior cruciate ligament reconstruction with hamstring tendons and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors

Janssen RPA, Du Mée AWF, Valkenburg v J, Sala HAGM, Tseng CM
Knee Surg Sports Traumatol Arthrosc. 2013;21-9:1977-1988

Purpose: Analysis of long-term clinical and radiological outcome after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors.

Methods: A prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4 strand hamstring tendon autografts with a standardised accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions.

Results:

Clinical outcome: A significant improvement (p<0.001) between preoperative and postoperative measurements could be demonstrated for the Lysholm and Tegner scores, IKDC patient subjective assessment, KT-1000 measurements, pivot shift test, IKDC score and one leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50%) patients and correlated with lower levels of activity (p<0.022).

Radiological outcome:At follow-up, 46 (53.5%) patients had signs of osteoarthritis (OA). In this group, 33 patients (72%) had chondral lesions (≥ grade 2) at time of ACL reconstruction. A history of medial meniscectomy before or at time of ACL reconstruction increased the risk of knee OA 4 times (95% CI 1.41-11.5). An ICRS grade 3 at time of ACL reconstruction increased the risk of knee OA by 5.2 times (95% CI 1.09-24.8). There was no correlation between OA and activity level (Tegner score ≥6) nor between OA and a positive pivot shift test.

Conclusion: Transtibial ACL reconstruction with 4 strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At ten year follow-up, radiological signs of OA were present in 53.5% of the subjects. Risk factors for OA were meniscectomy prior to, or at time of ACL reconstruction and chondral lesions at time of ACL reconstruction. 

Level of evidence: 2
Keywords: anterior cruciate ligament reconstruction – hamstring autograft – knee osteoarthritis – accelerated rehabilitation - long term - radiological 

This study has been presented at ESSKA 2012 Congress (Geneva, Switzerland), NOV Annual Congress 2013 (Amsterdam, The Netherlands), ISAKOS 2013 Congress (Toronto, Canada) and AGA Congress 2013 (Wiesbaden, Germany). 

http://www.ncbi.nlm.nih.gov/pubmed/23081710


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RPA Janssen, MD PhD 
Orthopaedic Surgeon
Orthopaedic Associates Eindhoven Greater Area
Orthopedic Center Máxima
Máxima Medical Center (MMC)

Visiting adress MMC Eindhoven:
Ds. Th. Fliednerstraat 1
Ingang Zuid
5631 BM  Eindhoven
The Netherlands 
(outpatient clinic and surgery)

Visiting adress MMC Veldhoven:
De Run 4600
5504 DB  Veldhoven
The Netherlands
(Outpatient clinic)

Mail adress:
Postbus 90052
5600 PD  Eindhoven
The Netherlands

Tel. 0031 (0)40 88 88 600
(Call center Orthopedie)

Fax: 0031 (0)40 88 85 938
www.rpajanssen.com 

Links:
Orthopaedic Associates Eindhoven Greater Area
Máxima Medical Center
Orthopaedic Center Máxima
 

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