Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis

Purpose: To evaluate the clinical outcomes and incidence of knee osteoarthritis (OA) and the factors associated with the onset of OA in the 3 compartments of the knee joint separately after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone autograft.

Methods: Clinical and radiologic assessments were obtained from 117 patients (80.1%). At follow-up, knee function was evaluated with the Lysholm score, Hospital for Special Surgery (HSS) score, Tegner score, and International Knee Documentation Committee (IKDC) 2000 forms. We also evaluated stability and donor-site morbidity. On the follow-up radiographs, OA was assessed by IKDC grading. The factors affecting the onset of OA in the 3 compartments of the knee joint were evaluated.

Results: The mean follow-up period was 10.3 ± 1.0 years. The mean Lysholm and HSS scores significantly increased at final follow-up (P < .001). The mean IKDC subjective score was 90.6, and 93.9% of patients had grade A or grade B knees on the objective evaluation. The mean side-to-side difference measured by KT-2000 arthrometer (MEDmetric, San Diego, CA) was 1.6 ± 1.7 mm, with 82.0% of patients showing a difference of less than 3 mm. Discomfort from knee walking on hard ground and skin numbness were reported by 38.4% and 37.6% of patients, respectively. OA developed in the medial, lateral, and patellofemoral compartments in 30.7%, 9.3%, and 7.6% of patients, respectively. The onset of OA was associated with partial meniscectomy (odds ratio [OR], 20.73; P = .005) or sagittal tibial tunnel position (OR, 1.18; P = .02) in the medial compartment and body mass index (BMI) (OR, 1.56; P = .02) in the lateral compartment.

Conclusions: ACL reconstruction with bone-patellar tendon-bone autograft showed satisfactory clinical results after a mean of 10.3 years. However, pain when walking on hard ground (38.4%) and numbness of the skin (37.6%) were reported. Moreover, the onset of OA appeared in over 40% of the patients. The onset of OA in the medial compartment was correlated with partial meniscectomy and sagittal tibial tunnel position, and the onset of OA in the lateral compartment was correlated with higher BMI.

Level of evidence: Level IV, therapeutic case series.