Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors

Rob P.A. Janssen, Arthur W.F. du Mée, Juliette van Valkenburg, Harm A.G.M. Sala, Carroll M. Tseng

Research output: Contribution to journalArticleAcademicpeer-review

65 Citations (Scopus)

Abstract

PURPOSE: Analysis of long-term clinical and radiological outcomes 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 standardized 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, USA) 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 the time of ACL reconstruction. A history of medial meniscectomy before or at the time of ACL reconstruction increased the risk of knee OA 4 times (95% CI 1.41-11.5). An ICRS grade 3 at the 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 10-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 the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction.

LEVEL OF EVIDENCE: II.

Original languageEnglish
Pages (from-to)1977-1988
Number of pages12
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume21
Issue number9
DOIs
Publication statusPublished - Sep 2013
Externally publishedYes

Keywords

  • Adult
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction/methods
  • Arthroscopy
  • Autografts
  • Female
  • Humans
  • Knee Injuries/complications
  • Male
  • Osteoarthritis, Knee/epidemiology
  • Prospective Studies
  • Tendons/transplantation
  • Treatment Outcome

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