Document Title: Maletius-AJSM-Nov99

Article Title: Eighteen- to twenty-four-year follow-up after complete rupture of the anterior cruciate ligament

Authors: Wolfgang Maletius, Karola Messner.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: November-December 1999.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 27

Issue: 6

Pages: 711-717

Key Words: Knee, ACL, rupture, long-term, degeneration, arthritis.

 

Maletius and Messner provide good insight into the cartilage-deleterious effects of knee instability. The study is one of the few that look at ACL injuries in the long term, and it clearly shows that evidence of progressively-worsening arthritic degeneration can be depended on to eventually accompany any type of full-ACL tearing (irrespective of how treated). (Of course, ACL reconstruction has advanced tremendously within the past two decades; primitive ACL-suturing attempts, crude extraarticular reconstructions, and biomechanically-horrendous artificial ligaments have thankfully been relegated to the status of mere historical curiosities. In this study, some of the patients did not undergo any surgery for their full ACL tearing; nearly all of the patients who did undergo the decidedly unsophisticated surgeries of the day experienced a very dismal failure at some point in time.) It was found that after 20 years of ACLlessness, well over half of the knees harboured compromised menisci. Maletius et al. note that the incidence of osteoarthritis is many times higher in people with full-ACL-rupture histories, as compared to the general population. The authors also point out that the Lachman test, particularly if performed without anesthesia, depends somewhat on the examiner's tactile abilities. It was noted that isolated ACL injuries are usually rare; thus whenever an ACL injury occurs, other structures (e.g. MCL, articular cartilage, trabecular/subcortical bone) are often injured along with it.

 

ABSTRACT

A unilateral, complete rupture of the anterior cruciate ligament was diagnosed in 60 consecutive patients by arthroscopy within 1 week of trauma. Most ruptured ligaments were treated by acute nonaugmented (i.e. no artificial reinforcing device) repair immediately after the arthroscopy.  (Note that at the time these patients were originally operated on, the standard consisted simply of stitching the torn ACL ends back together.  Of course, such treatment is now known to be wholly inadequate.  Some of the patients in this study did undergo tendon-graft reconstructions; a few underwent now-obsolete procedures such as artificial-graft implantations.)  Fifty-five and 56 patients were reevaluated after 12 years and 20 years, respectively. Twenty-five patients (45%) had at least one re-operation during the follow-up period of 20 years, primarily for meniscal problems. Seven patients (13%) had repeat anterior cruciate ligament surgery. The overall Lysholm knee function score remained at a median of 90 points from 12 to 20 years, but patients had decreased their sporting activities from team sports at full rehabilitation to physical fitness activities at the late follow-up. Patients who had repeat surgery had a worse knee function score, were less satisfied with their knees, and also had to change activities and change work more often than patients without re-operation. The majority of patients had, at both follow-up periods, unstable knees. At 20 years, weightbearing radiographs showed slight-to-moderate changes equivalent to osteoarthrosis in 84% (47) of patients and a 32% increase in osteoarthrosis since the 12-year evaluation.

 

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