Arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: a 14-year follow-up study
Biplab Kumar Dolai, Neeraj Ahuja, Ashok Rajgopal
Department of Orthopedics, Fortis Hospital, India
Keywords: Anterior cruciate ligament/surgery; arthroscopy; bone-patellar tendon-bone graft; knee joint; tendons/transplantation
Objectives: We evaluated the long-term results of arthroscopic anterior cruciate ligament (ACL) reconstruction with autogenous bone-patellar tendon-bone graft in athletes.
Patients and methods: A total of 112 athletes (82 males, 30 females; mean age 27 years; range 20 to 35 years) underwent ACL reconstruction with central third of bone-patellar tendon-bone autograft. The mean time from injury to surgery was 18 months (range 2 days to 26 months). Thirty-eight patients had acute symptoms. Preoperatively, the Lachman and pivot shift tests were positive in all the patients. After a minimum of 14 years (mean 15.8 years), all the patients were assessed by subjective evaluations, and objectively with the KT-1000 arthrometer testing, radiographs as well as second-look arthroscopy in 39 patients.
Results: On subjective evaluations, the results were excellent in 62 (55.4%), good in 33 (29.5%), fair in 12 (10.7%), and poor in five patients (4.5%). No limitation of movement was seen in 95 patients (84.8%). The Lachman and pivot shift tests were negative in 74 (66.1%) and 99 (88.4%) patients, respectively. Radiographically, osteoarthritic changes were detected in 17 patients (15.2%), whose results were fair or poor, who had associated meniscal or osteochondral injuries prior to surgery, and who gave up preinjury sports activities. In KT-1000 arthrometer testing, side-to-side difference was less than 2 mm in 74 patients. At second-look arthroscopy, 30 patients had well-remodelled grafts; of these 11 patients had a positive Lachman test, and three patients had a positive pivot shift test. Spontaneous lysis of various degrees was detected in nine patients, of whom only two had a positive Lachman test.
Conclusion: Reconstruction of the ACL using a bone-patellar tendon-bone graft is recommended for acute or chronic ACL deficiency in athletes.