15 Year outcomes in Anterior Cruciate Ligament reconstructed patients
Leo Pinczewski’s study in the January 2011 edition of the AJSM has some interesting information.
In his article he followed 90 isolated ACL reconstructed patients over 15 years. 24% had a tear of the contra lateral ACL during that time and 8% ruptured their graft.
A vertically placed graft had a 10 times greater chance of an ACL graft rupture.
This is good news because in the last 5 years there has been a change in surgical technique where now surgeons are drilling the femoral tunnel through the medial portal so that the tunnel is more lateral than vertical. It is likely that this change in technique is resulting in fewer graft ruptures.
51% of patients had x-ray evidence of osteoarthritis at 15 years. The study showed
that the incidence of radiographic OA is lower in patients treated with ACL reconstruction compared with previous reports of patients with nonoperative treatment of ACL deficiency.
Younger patients are obviously more likely to have further trouble as they are more likely to continue to play at a higher level for longer. Patients did better after lateral meniscectomy compared with medial meniscectomy, with more patients progressing to OA after medial meniscectomy. Therefore, the effect of a less than one-third lateral meniscectomy on long-term functional and radiographic outcome is most likely minimal.
Of the 7 patients with meniscal repairs, only 1 patient who had medial meniscal repair required later meniscectomy, indicating that the other 6 patients had successful meniscal repair and were able to save their menisci.
All this is not bad news for this group of patients. However this represents only 90 of the 333 ACL reconstructions performed by Leo Pinczewski between January 1993 and April 1994. Exclusion criteria included any associated ligament injury requiring surgery, evidence of chondral damage or degeneration, previous meniscectomy or meniscal injury requiring
more than one-third meniscectomy at the time of reconstruction, abnormal radiograph results, abnormal contra lateral knee, patients seeking compensation for their injuries, and patients who did not wish to participate in a research study. Therefore, the study group consisted of
90 patients with an essentially isolated ACL injury.
To give a patient information before surgery I would like to know how the other 2/3 of patients do.
How does a total / near total meniscectomy affect outcome?
How does chondral damage affect outcome?