Long-term results excellent after ACL repair

By Will Boggs, MD

NEW YORK (Reuters Health) - Most patients have normal or nearly normal knee function 13 years after they undergo reconstruction of the anterior cruciate ligament (ACL), according to a report by an Australian team.

"ACL reconstruction is effective in restoring stability and function over the long-term, but preservation of the (knee cartilage) ensures the most successful outcome," Dr. Lucy J. Salmon from Australian Institute of Musculoskeletal Research, Sydney, told Reuters Health.

Salmon and her colleagues report the findings at 5, 7 and 13 years after surgery in 67 patients who underwent minimally invasive endoscopic ACL reconstruction without significant damage to the joint surfaces.

Forty-seven of 49 patients (96 percent) who completed a questionnaire rated their knee function as normal or nearly normal 13 years after their ACL reconstruction, the investigators report in The American Journal of Sports Medicine.

After 13 years, most patients could perform moderate to strenuous activities without pain (92 percent), swelling (96 percent), or giving way (96 percent), the researchers note.

Moreover, nearly half the patients reported continued participation in strenuous or moderate activity at the 13-year follow-up, a slight decrease from 56 percent of the patients at the 7-year mark.

Having to remove a meniscus -- crescent-shaped cartilage in the knee joint -- "is associated with greater laxity of the reconstructed ACL, and potentially higher rates of graft re-injury or failure," Salmon explained.

The likelihood that a meniscus becomes damaged and has to be removed increases the longer the ACL has been damaged, she continued, "so perhaps the best way to minimize meniscal injury requiring resection is to reconstruct the ACL in the subacute period before further episodes of instability result in more meniscal damage in young active patients."

Concluding, Salmon said, "We hope to review these patients again at 20 years from surgery, i.e., in 2009."

SOURCE: American Journal of Sports Medicine, May 2006.