Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-10-19

AUTHORS

Rob P. A. Janssen, Arthur W. F. du Mée, Juliette van Valkenburg, Harm A. G. M. Sala, Carroll M. Tseng

ABSTRACT

PurposeAnalysis of long-term clinical and radiological outcomes after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors.MethodsA prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4-strand hamstring tendon autografts with a standardized accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA, USA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions.ResultsClinical outcome A significant improvement (p < 0.001) between preoperative and postoperative measurements could be demonstrated for the Lysholm and Tegner scores, IKDC patient subjective assessment, KT-1000 measurements, pivot shift test, IKDC score and one-leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50 %) patients and correlated with lower levels of activity (p < 0.022). Radiological outcome: At follow-up, 46 (53.5 %) patients had signs of osteoarthritis (OA). In this group, 33 patients (72 %) had chondral lesions (≥grade 2) at the time of ACL reconstruction. A history of medial meniscectomy before or at the time of ACL reconstruction increased the risk of knee OA 4 times (95 % CI 1.41–11.5). An ICRS grade 3 at the time of ACL reconstruction increased the risk of knee OA by 5.2 times (95 % CI 1.09–24.8). There was no correlation between OA and activity level (Tegner score ≥6) nor between OA and a positive pivot shift test.ConclusionTranstibial ACL reconstruction with 4-strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At 10-year follow-up, radiological signs of OA were present in 53.5 % of the subjects. Risk factors for OA were meniscectomy prior to or at the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction.Level of evidenceII. More... »

PAGES

1977-1988

References to SciGraph publications

  • 2012-07-05. Regeneration of hamstring tendons after anterior cruciate ligament reconstruction in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2011-02-04. Remodelling of human hamstring autografts after anterior cruciate ligament reconstruction in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2011-05-18. Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1998-04. Double semitendinosus anterior cruciate ligament reconstruction: 10-year results in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2011-11-03. Bone-patellar tendon-bone autograft versus hamstring autograft anterior cruciate ligament reconstruction in the young athlete: a retrospective matched analysis with 2–10 year follow-up in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2012-01-05. Pivot shift as an outcome measure for ACL reconstruction: a systematic review in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1999-03. Anterior Cruciate Ligament Reconstruction and the Long Term Incidence of Gonarthrosis in SPORTS MEDICINE
  • 2011-09-07. Knee function and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: long-term follow-up in INTERNATIONAL ORTHOPAEDICS
  • 2008-02-22. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00167-012-2234-9

    DOI

    http://dx.doi.org/10.1007/s00167-012-2234-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1017816401

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/23081710


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    40 Kellgren
    41 Lawrence
    42 Lysholm
    43 MethodsA
    44 PurposeAnalysis
    45 ResultsClinical outcome
    46 Rosenberg
    47 Tegner score
    48 X-ray
    49 accelerated rehabilitation protocol
    50 activity
    51 activity levels
    52 analysis
    53 anterior cruciate ligament reconstruction
    54 anteroposterior knee stability
    55 assessment
    56 attention
    57 autograft
    58 bearing
    59 case series
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    61 circumference measurements
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    64 clinical parameters
    65 clinical results
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    67 correlation
    68 cruciate ligament reconstruction
    69 evaluation
    70 examination
    71 factors
    72 follow
    73 grade 3
    74 group
    75 hamstring autograft
    76 hamstring tendon autograft
    77 history
    78 hop test
    79 improvement
    80 knee
    81 knee osteoarthritis
    82 knee stability
    83 lateral knee
    84 leg circumference measurements
    85 lesions
    86 levels
    87 ligament reconstruction
    88 logistic regression
    89 low levels
    90 measurements
    91 medial meniscectomy
    92 meniscectomy
    93 one-leg hop test
    94 osteoarthritis
    95 outcomes
    96 parameters
    97 patient satisfaction
    98 patients
    99 patients' subjective assessment
    100 phenomenon
    101 pivot shift test
    102 pivot-shift phenomenon
    103 positive pivot shift test
    104 postoperative measurements
    105 predictors
    106 prospective study
    107 protocol
    108 radiological classification
    109 radiological evaluation
    110 radiological outcomes
    111 radiological signs
    112 reconstruction
    113 regression
    114 rehabilitation
    115 rehabilitation protocol
    116 results
    117 risk
    118 risk factors
    119 satisfaction
    120 scores
    121 series
    122 shift phenomenon
    123 shift test
    124 significant improvement
    125 signs
    126 signs of osteoarthritis
    127 special attention
    128 stability
    129 statistical analysis
    130 study
    131 subjective assessment
    132 subjects
    133 tendon autograft
    134 test
    135 testing
    136 time
    137 transtibial ACL reconstruction
    138 univariate
    139 view X-ray
    140 weight bearing
    141 years
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