als PDF - AGA

27. AGA-Kongress 2010 - Wien
P 13
Long term results of anterior cruciate ligament reconstruction: A comparison with nonoperative
treatment with a follow-up of 15 to 20 years
Mihelic R.
Medical School University of Rijeka, Orthopaedic Clinic, Lovran, Croatia
In a non-randomised study we have compared anterior cruciate ligament (ACL) reconstruction using
bone-patellar tendon-bone (BTB) graft with a non operatively treated group of patients 15-20 years
later. Eighty-six patients with arthroscopically proved ACL rupture were treated between 1989 and
1994. Fifty-two patients who had severe symptoms of giwing way were submitted to the ACL
reconstruction 3-24 months later (mean 19 ), forming group one. Second group of 34 patients,
continued with non-operative treatment. IKDC subjective and objective evaluation forms were used to
asses the knee stability. Tegner activity scale and Lysholm knee score were used to control level of
activity before and after injury. Radiographic assesment was performed using IKDC grading scale.
Follow up results show that 85% of operated patients had stable knees and normal or nearly normal
IKDC grade. They were able to return to the same level of high sports activities (21 %), or keep the
same level of recreational activity (21%). Others switched one level down. In the group two, not one
patient could keep high level of activities, 35% of patients could keep the same level of recreational
sport, but all others gave up. Subjective IKDC score was significantly in favour of operated group of
patients: 79,1 in group one compared to 73,2 in group two. Osteoarthritis rate in group one showed
15% of normal knees, 44% mild degenerative changes, 15% grade two OA and in 25% we found
severe changes, the result that we did not expect. In group two there were no normal knees, but 23%
of mild OA, 12% grade two and 65% of severe degenerative changes. We conclude that our study
showed a high percentage of 25% of patients with severe osteoarthritis 15 years after reconstruction
of anterior cruciate ligament, so we cannot believe that the recontruction prevents osteoarthritis.
Furtheremore, we cannot corelate degenerative changes with meniscectomy.
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