Very long-term osteoarthritis rate after anterior cruciate ligament reconstruction: 182 cases with 22-year’ follow-up - 02/02/20

Doi : 10.1016/j.otsr.2019.09.034

Jonathan Curado ^a,⁎ , Christophe Hulet ^a,^b,⁎ , Philippe Hardy ^c,^{^{1
Deceased author.}}, Jean-Yves Jenny ^d, Romain Rousseau ^e, Antoine Lucet ^a, Camille Steltzlen ^f, Vincent Morin ^g, Olivier Grimaud ^h, Nicolas Bouguennec ⁱ, Nicolas Pujol ^f, Bertrand Sonnery-Cottet ^j, Nicolas Graveleau ⁱ
the French Society for Orthopaedic, Trauma Surgery (Société française de chirurgie orthopédique et traumatologique, SoFCOT)^k
^a Département de chirurgie orthopédique et traumatologique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France
^b Unité Inserm U1075 Comète, PFRS–université de Caen, 2, rue des Rochambelles, 14032 Caen cedex 5, France
^c Service de chirurgie orthopédique, hôpital Ambroise-Paré, Assistance publique–Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne Billancourt, France
^d Service de chirurgie orthopédique et traumatologique, hôpitaux universitaires de Strasbourg, 10, avenue Achille-Baumann, 67400 Illkirch, France
^e Institut de l’appareil locomoteur Nollet, 23, rue Brochant, 75017 Paris, France
^f Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
^g Service de chirurgie orthopédique et traumatologique, CHU de Grenoble hôpital Sud, avenue de Kimberley, 38130 Échirolles, France
^h Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
ⁱ CCOS et clinique du sport de Bordeaux Mérignac, 2, avenue Georges-de-Negrevergne, 33700 Mérignac, France
^j Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
^k 56, rue Boissonade, 75014 Paris, France

^⁎Corresponding authors at: Département de chirurgie orthopédique et traumatologique, CHU de Caen, avenue de la Côte-de-Nacre, Caen 14033, France.Département de chirurgie orthopédique et traumatologique, CHU de Caenavenue de la Côte-de-NacreCaen 14033France

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Abstract

Background

Few data are available on the 20-year outcomes of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to assess the prevalence and risk factors of knee osteoarthritis at least 20 years after ACL reconstruction.

Hypothesis

Factors associated with progression to knee osteoarthritis include meniscal lesions, level of physical activity, injury-to-surgery time, body mass index, residual laxity, tunnel position and cartilage injury.

Material and methods

One hundred and eighty two patients were included in a multicentre retrospective study conducted in the setting of a SoFCOT symposium. Females contributed two-thirds of the study population. ACL reconstruction was performed arthroscopically in 82% of cases, and a bone-patellar tendon-bone transplant was used in 92.8% of cases. Mean age at surgery was 26±7years. Clinical outcomes were assessed based on the objective and subjective IKDC scores and on the KOOS. Radiographic evidence of osteoarthritis was classified according to the IKDC. Factors evaluated for their ability to predict progression to osteoarthritis included age, sex, body mass index, level of physical activity, injury-to-surgery time, meniscectomy, cartilage injury, tunnel position and residual laxity.

Results

At last follow-up, the objective IKDC score was A (normal) for 48%, B for 35%, and C or D for 17% of the knees. The mean subjective IKDC score was 82.7±13.1. Moderate-to-severe osteoarthritis was present in 29% of cases. The following risk factors for osteoarthritis were identified: medial or lateral meniscectomy, residual laxity, age >30years at surgery, and engaging in a pivoting sport. Meniscectomy was a major contributor to the development of osteoarthritis (17% of knees without vs. 46% with meniscectomy). Finally, the ACL re-tear rate was 13%.

Conclusion

ACL reconstruction provides satisfactory knee stability. The risk of subsequent osteoarthritis depends chiefly on the status of the menisci. Residual laxity is also associated with the development of osteoarthritis.