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Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15–23 years postoperatively

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Abstract

Introduction

We have previously reported results after 2–5 and 5–10 years follow-up of repair of acute anterior cruciate ligament (ACL) ruptures by suturing. Reports of results after more than 10 years are rare.

Materials and methods

A total of 140 patients were operated on in the period 1975–1983 (age range 13–71 years, median 28 years) by the modified Palmer technique. Only 2 meniscus resections and 4 meniscectomies were performed at the primary operation; while 28 menisci were sutured. At follow-up,12 patients were dead. Eighteen patients (13%) underwent repeat operations for secondary instability. Of the remaining 110 patients, 81 appeared for follow-up.

Results

Only 6 secondary meniscus resections were performed, all in the group of 18 patients operated on again for instability. No secondary meniscus surgery was performed on the 81 patients who appeared for follow-up. The median Lysholm score was 88, and 58 of the 81 patients (71%) classified their total knee function as good or excellent. By KT-1000 testing, 33 (41%) patients had less than 3 mm anterior instability, 29 (36%) had 3–5 mm instability, and 17 (21%) had more than 5 mm. With 18 patients from the total of 128 living patients re-operated for instability, we estimate the rate of total failure of stability as 27%. Radiological osteoarthritis grade C was present in 8 operated and 2 control knees, while only 1 operated knee revealed osteoarthritis grade D. Thirty-four operated and 20 control knees had grade B. Osteoarthritis was correlated to more advanced age at injury, while correlation to function could not be proven. Radiographs were obtained of 61 patients at follow-up.

Conclusions

Some 50% of patients had stable or slightly unstable knees, and 40% good or excellent function according to the Lysholm score. Re-operation for instability was more frequent in younger patients, while ostearthritis was more frequent in older patients. The rate of meniscus resection or extirpation was low. Open repair by suture is no longer recommended. Further research is indicated on the possible use of refixation of the ruptured ACL by arthroscopy.

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References

  1. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1992) Long term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis. Am J Sports Med 20:38–45

    CAS  PubMed  Google Scholar 

  2. Aroen A, Strand T, Molster A (1992) Primary suture of the posterior cruciate ligament (in Norwegian). Tidsskr Nor Laegeforen 112:1582–1584

    CAS  PubMed  Google Scholar 

  3. Casteleyn PP (1999) Management of anterior cruciate ligament lesions: surgical fashion, personal whim or scientific evidence? Study of medium- and long-term results. Acta Orthop Belg 65:327–339

    CAS  PubMed  Google Scholar 

  4. Daniel DM, Malcom L, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–725

    CAS  PubMed  Google Scholar 

  5. Daniel DM, Stone ML, Dobseon BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22:632–644

    CAS  PubMed  Google Scholar 

  6. Engebretsen L, Benum P, Fasting O, Molster A, Strand T (1990) A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med 18:585–590

    CAS  PubMed  Google Scholar 

  7. Feagin JA, Curl WW (1976) Isolated tears of the anterior cruciate ligament: 5 years follow up. Am J Sports Med 4:95–100

    PubMed  Google Scholar 

  8. Gillquist J, Messner K (1999) Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 27:143–156

    CAS  PubMed  Google Scholar 

  9. Grøntvedt T, Engebretsen L, Benum P, Fasting O, Mølster A, Strand T (1996) A prospective, randomized study of three operations for acute rupture of the anterior cruciate ligament. Five-year follow-up of one hundred and thirty-one patients. J Bone Joint Surg Am 78:159–168

    PubMed  Google Scholar 

  10. Hefti F, Muller W, Jakob RP, Staubli H-U (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthroscopy 1:226–234

    CAS  Google Scholar 

  11. Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med 18:354–358

    CAS  PubMed  Google Scholar 

  12. Kdolsky R, Kwasny O, Schabus R (1993) Synthetic augmented repair of proximal ruptures of the anterior cruciate ligament. Long-term results of 66 patients. Clin Orthop 295:183–189

    PubMed  Google Scholar 

  13. Maletius W, Gillquist J (1997) Long-term results of anterior cruciate ligament reconstruction with a Dacron prosthesis. The frequency of osteoarthritis after seven to eleven years. Am J Sports Med 25:288–293

    CAS  PubMed  Google Scholar 

  14. Maletius W, Messner K (1999) Eighteen- to twenty-four-year follow-up after complete rupture of the anterior cruciate ligament. Am J Sports Med 27:711–717

    CAS  PubMed  Google Scholar 

  15. Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop 143:97–106

    PubMed  Google Scholar 

  16. Messner K, Maletius W (1999) Eighteen- to twenty-five-year follow-up after acute partial anterior cruciate ligament rupture. Am J Sports Med 27:455–459

    CAS  PubMed  Google Scholar 

  17. Natri A, Jarvinen M, Kannus P (1996) Primary repair plus intra-articular iliotibial band augmentation in the treatment of an acute anterior cruciate ligament rupture. A follow-up study of 70 patients. Arch Orthop Trauma Surg 115:22–27

    Article  CAS  PubMed  Google Scholar 

  18. Noyes FR, Basset RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic haemarthrosis of the knee. J Bone Joint Surg Am 62:687–695

    CAS  PubMed  Google Scholar 

  19. Odensten M, Lysholm J, Gillquist-J (1984) Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up. Acta Orthop Scand 55:270–272

    CAS  PubMed  Google Scholar 

  20. Palmer I (1938) On the injuries to the ligaments of the knee joint. Acta Chir Scand Suppl 53

  21. Sandberg R, Balkfors B, Nilsson B, Westlin N (1987) Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am 69:1120–1126

    CAS  PubMed  Google Scholar 

  22. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I (1991) The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med 19:243–255

    CAS  PubMed  Google Scholar 

  23. Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotatory instability of the knee. Clin Orthop 118:63–69

    PubMed  Google Scholar 

  24. Strand T, Engesaeter LB, Molster AO (1985) Meniscus repair in knee ligament injuries. Acta Orthop Scand 56:130–132

    CAS  PubMed  Google Scholar 

  25. Strand T, Engesaeter LB, Molster AO, Raugstad TS, Stangeland L, Stray O, Alho A (1984) Knee function following suture of fresh tear of the anterior cruciate ligament. Acta Orthop Scand 55:181–184

    CAS  PubMed  Google Scholar 

  26. Strand T, Mølster AO (1988) Five to ten-year follow-up after primary suture of anterior cruciate ligament tears. Surgery and Arthroscopy of the Knee, 2nd Congress of the European Society (ESKA). Springer, Berlin Heidelberg New York

  27. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

    PubMed  Google Scholar 

  28. Zysk SP, Refior HJ (2000) Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients. A follow-up study of 133 patients between the ages of 40 and 59 years. Arch Orthop Trauma Surg 120:59–64

    CAS  PubMed  Google Scholar 

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Acknowledgement

We want to thank Stein Atle Lie for statistical advice and calculations.

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Correspondence to A. Mølster.

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Strand, T., Mølster, A., Hordvik, M. et al. Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15–23 years postoperatively. Arch Orthop Trauma Surg 125, 217–221 (2005). https://doi.org/10.1007/s00402-004-0766-2

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