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Long-Term Results of Arthroscopic ACL Repair

Researchers from the Australian Institute of Musculoskeletal Research offer one of the first reports of long-term results from arthroscopic anterior cruciate ligament (ACL) repair. Patients were followed at least 10 years.

All patients had ACL reconstruction using a patellar tendon autograft. Autograft means the tissue was taken from the patient's own knee. The patellar tendon is located at the front of the knee just below the patella (kneecap). A single incision method was used to perform the reconstruction. If the meniscus was torn, it was also repaired at the same time.

The authors report excellent long-term results 13 years later. Most patients could do moderately strenuous activities without pain, swelling, or giving way of the knee. More patients had swelling after the first seven years than any other symptom. Joint laxity (looseness) was more common in athletes who had the meniscus removed.

They found that graft rupture was more likely to occur in athletes younger than 21 years. The risk of rupture was greater in those who had the meniscus removed. The authors suggest graft rupture after ACL repair with meniscectomy shows the effect of years of increased strain on the graft. Males and females were affected by graft rupture in equal numbers.

Three-fourths of the patients had signs of arthritis seen on X-rays. Almost half also had loss of full knee extension, another sign of arthritis. These changes were first noticed between five and seven years after the ACL surgery.

The authors conclude the long-term results of endoscopic ACL reconstruction are good. There were signs of degenerative changes but function remained good. Increased joint laxity was more common in patients who had a meniscectomy. They suggest early ACL repair after injury to avoid the risk of a meniscal injury later with joint degeneration in the long run.

References: Lucy J. Salmon, BAppSci(Physio), et al. Long-term Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft. In The American Journal of Sports Medicine. May 2006. Vol. 34. No. 5. Pp. 721-732.

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