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
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
Aroen A, Strand T, Molster A (1992) Primary suture of the posterior cruciate ligament (in Norwegian). Tidsskr Nor Laegeforen 112:1582–1584
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
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
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
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
Feagin JA, Curl WW (1976) Isolated tears of the anterior cruciate ligament: 5 years follow up. Am J Sports Med 4:95–100
Gillquist J, Messner K (1999) Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 27:143–156
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
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
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
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
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
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
Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop 143:97–106
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
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
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
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
Palmer I (1938) On the injuries to the ligaments of the knee joint. Acta Chir Scand Suppl 53
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
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
Slocum DB, James SL, Larson RL, Singer KM (1976) Clinical test for anterolateral rotatory instability of the knee. Clin Orthop 118:63–69
Strand T, Engesaeter LB, Molster AO (1985) Meniscus repair in knee ligament injuries. Acta Orthop Scand 56:130–132
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
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
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49
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
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We want to thank Stein Atle Lie for statistical advice and calculations.
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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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DOI: https://doi.org/10.1007/s00402-004-0766-2