Injuries to the anterior cruciate ligament (ACL) can be treated either with or without surgery. Although some patients do well without surgery, most patients benefit most with surgery.
Patients seem to get good short-term results from ACL surgery. Few studies have looked at the results five or more years down the line. This study zeroed in on the mid-term results of ACL surgery in patients who showed no damage in their knee meniscus. The meniscus is a protective pad between the thighbone (femur) and the shinbone (tibia). It is sometimes referred to as “knee cartilage.”
Doctors performed this surgery using tissue from a hamstring muscle called the semitendinosis muscle. A strand of tendon from this muscle was folded twice (quadrupled) to form a strong replacement for the injured ACL.
Twenty patients were examined five to seven years after surgery. Most of the patients were male. Their average age at the time of surgery was 31. About half of them had surgery within two months of initial injury. The other half had been having knee problems for a longer period of time.
Overall, the authors were impressed with the results. An average of six years after surgery, patients’ ability to bend and straighten their knees was normal. A few patients had some limitations in movement, but these were slight.
Six patients said they still had some knee pain at follow-up: three during daily activities and three during sports. About half of the patients had kept up their normal activities after surgery. The other half was slightly less active. This change had more to do with patients’ work and lifestyle than with their knees.
The authors feel that ACL surgery using a quadrupled semitendinosis tendon has excellent mid-term results. Almost all of the patients had “normal” or “nearly normal” knees at follow-up. Patients seldom needed more surgery. And degeneration of the knee after surgery was rare. The authors recommend early treatment for ACL tears, before the meniscus becomes injured and needs to be removed.