Original Article
No Increased Occurrence of Osteoarthritis After Anterior Cruciate Ligament Reconstruction After Isolated Anterior Cruciate Ligament Injury in Athletes

https://doi.org/10.1016/j.arthro.2011.09.014Get rights and content

Purpose

To evaluate the long-term radiographic and clinical results of anterior cruciate ligament (ACL) reconstruction by comparing the injured knee with the contralateral knee in athletes with isolated ACL tear returning to preinjury sports.

Methods

Twenty-eight patients with isolated ACL tears without concomitant injuries at baseline returning to previous sports were selected. ACL reconstruction was performed with patella or hamstring tendon graft. Conventional radiographs and a 3-T magnetic resonance imaging study of both knees were obtained at a mean follow-up of 10 years after ACL reconstruction and were compared with each other. The International Knee Documentation Committee score and Tegner activity index were used for clinical evaluation and the Knee Injury and Osteoarthritis Outcome Score for evaluating self-reported knee function.

Results

The 3-T magnetic resonance imaging study showed positive signs of osteoarthritis in 33% of operated knees and 39% of nonoperated knees (P = .64). Conventional radiographs showed ongoing signs of radiographic osteoarthritis in 14% of uninjured knees according to Kellgren and Lawrence, in comparison with 21% of injured knees (P = .73). The functional outcomes between the injured knee and uninjured knee did not show any statistical differences. The mean postoperative International Knee Documentation Committee score was 89.2 ± 9.3 points, and the total Knee Injury and Osteoarthritis Outcome Score was 92.7 ± 7.8. The median preinjury Tegner score was 8 ± 2, corresponding to 7 ± 2 at follow-up. In 68% of patients, the Tegner score was unchanged from preinjury to follow-up.

Conclusions

Athletes with an isolated ACL rupture showed no increased risk of the development of post-traumatic osteoarthritis in the long-term after ACL replacement when compared with the uninjured contralateral knee. Our findings support the evidence to perform ACL replacement in athletes.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

This study uses data collected from 1995 until 2005 taken from our knee database. All patients with an isolated rupture of the ACL related to a trauma while playing soccer or skiing who underwent ACL reconstruction and returned to previous sports activity were included. We excluded all patients with accompanying injuries involving the meniscus, posterior cruciate ligament, cartilage, and collateral ligaments, as well as any injury to the contralateral knee. Any postoperative complication to the

Clinical Evaluation at Follow-up

In 9 (56%) of the injured soccer players, the dominant (kicking) leg was affected. The evaluation of knee stability showed a misalignment of the ACL graft in 1 patient, which was classified as abnormal according to IKDC testing, because of a positive pivot shift and a positive anterior drawer test of more than 10 mm. All the others showed a defined endpoint, of which 61% had normal stability (–1 to +2 mm) (group A), 36% had nearly normal stability (+3 to +5 mm) (group B), and 3% had abnormal

Discussion

The results from our study confirmed the hypothesis that the long-term prevalence of OA would not be increased in athletes returning to preinjury sports after ACL reconstruction after isolated ACL rupture when we compared the injured knee with the uninjured contralateral knee.

The literature is full of articles dealing with ACL injuries and their treatment. To increase the meaningfulness of this study, we focused on a selected and very limited but absolutely homogeneous group of patients.

Conclusions

Athletes with an isolated ACL rupture showed no increased risk of the development of post-traumatic OA in the long-term after ACL replacement when compared with the uninjured contralateral knee. Our findings support the evidence to perform ACL replacement in athletes.

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  • Cited by (0)

    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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