Anterior Cruciate Ligament Reconstruction and Radiographic Progression to Knee Osteoarthritis

Abstract

The aim of this study was to evaluate the radiological progression to knee osteoarthritis (OA), including compare the results of semitendinous and gracilis (STG) and bone-patellar tendon-bone (BPTB) grafts.

This is a retrospective study that assessed patients submitted to anterior cruciate ligament (ACL) reconstruction with more than 8 years follow-up, between 2005 and 2011. Tegner activity scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analogue Scale (VAS) were used to evaluate patient perceptions of symptoms and function. The degree and location of OA were evaluated according to Kellgren and Laurence classification. Progression to radiographic Knee OA was assessed according to Felson et al. and symptomatic patients were identified.

We evaluate 38 patients with history of ACL reconstruction, with a mean follow-up time of 9.86 years. 22 (57.9%) patients were submitted to STG and 16 (42.1%) to bone-patellar tendon-bone grafts.

Radiographic OA was present in 20 (52.6%) patients, with 17 (44.7%) symptomatic at final follow-up. OA of the medial compartment was the most frequent, with 26 (68.4%) patients. A significant difference was found in progression to radiographic OA in BPTP and STG groups: 12/16 (75%) and 8/22 (36.4%) respectively; as well as in symptomatic OA, 11/17 (64.7%) and 6/17 (35.3%) respectively.

Similarly, the results of function and satisfaction levels were superior in STG group (KOOS 86.05, Tegner 5, VAS 8.1) than in BPTB group (KOOS 64.38, Tegner 4, VAS 6.3).

This study shows that ACL reconstruction did not protect the knee from secondary OA at 8 years of follow-up. The study also showed that graft type can affect the risk of radiographic and symptomatic progression to OA.