Purpose: The incidence and progression of osteoarthritis over a time period of 35 years following
anterior cruciate ligament (ACL) disruption in high-level athletes has not been clearly
determined. Our study examined this. Type of Study: Retrospective cohort clinical study. Methods: Following a central guideline, between March 1963 and December 1965, all 19 athletes
in the Olympic program of former East Germany who sustained an ACL injury were treated
without reconstruction. In a retrospective cohort study, the clinical results were
evaluated for all patients from 1975 and 1985 and for 17 of the 19 patients in 2000;
18 of the 19 patients were examined arthroscopically in 1985. Results: All patients were able to return to sports after a period of 6 to 14 weeks. Ten years
after the injury, meniscectomy had to be performed in 15 of the 19 patients (79%).
The medial meniscus was affected in 13 patients (68%) and the lateral in 7 (37%);
20 years after the injury, meniscectomy was necessary in 18 of the 19 patients (95%).
In 1985, in 18 of the 19 knees, arthroscopy was performed and 13 patients (68%) had
a grade 4 chondral lesion. Ten total knee replacements had to be performed until the
end of the year 2000. Conclusions: We conclude that, despite the possibility of return to high-level activity with a
definitive unstable knee, this will lead in 95% of cases to meniscal and cartilage
damage over the next 20 years. In addition, cartilage damage and progressive osteoarthritis
will occur and patients will have a high risk of becoming a candidate for further
total joint replacement. Level of Evidence: Level IV.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The natural history of the meniscus in anterior cruciate insufficiency. Arthroscopic analysis.J Bone Joint Surg Br. 1992; 74: 403-405
- Fate of the ACL-injured patient. A prospective outcome study.Am J Sports Med. 1994; 22: 632-644
- Knee joint changes after meniscectomy.J Bone Joint Surg Br. 1948; 30: 664-670
- Osteoarthritis of the knee following meniscectomy.Br J Rheumatol. 1994; 33: 267-268
- Gonarthrosis after injury of the anterior cruciate ligament.Z Unfallchir Versicherungsmed. 1993; 86: 81-89
- Sports capacity after rupture of the anterior cruciate ligament—Surgical versus non-surgical therapy.Aktuelle Traumatol. 1993; 23: 371-375
- Treatment of acute isolated and combined ruptures of the anterior cruciate ligament. A long-term follow-up study.Am J Sports Med. 1992; 20: 7-12
- Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients.Am J Sports Med. 1995; 23: 160-165
- The conservative treatment of the anterior cruciate deficient knee.Am J Sports Med. 1990; 18: 618-623
- Early season anterior cruciate ligament tears. A treatment dilemma.Am J Sports Med. 1997; 25: 656-658
- Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment.J Bone Joint Surg Am. 1988; 70: 1483-1488
- Surgical or conservative treatment of the acutely torn anterior cruciate ligament. A randomized study with short-term follow-up observations.Clin Orthop. 1985; 198: 87-93
- Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee.J Bone Joint Surg Am. 1984; 66: 741-744
- Instability and osteoarthritis.in: Fu F. Harner C. Vince K. Knee surgery. Williams & Wilkins, Baltimore1994: 859-875
- Secondary damage to the knee after isolated injury of the anterior cruciate ligament.Am J Sports Med. 1990; 18: 475-479
- In-vitro measurement of static pressure distribution in synovial joints—Part I.J Biomech Eng. 1983; 105: 216-225
- Meniscal tears: The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report.Am J Sports Med. 1986; 14: 270-275
- The effect of medial meniscectomy on strain distribution in the proximal part of the tibia.J Bone Joint Surg Am. 1984; 66: 1431-1437
- In vitro contact stress distribution on the femoral condyles.J Orthop Res. 1984; 2: 190-199
- Mechanical changes in the knee after meniscectomy.J Bone Joint Surg Am. 1976; 58: 599-604
- The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision.J Bone Joint Surg Am. 1986; 68: 71-79
- The natural history of the anterior cruciate ligament-deficient knee. Changes in synovial fluid cytokine and keratan sulfate concentrations.Am J Sports Med. 1997; 25: 751-754
Article info
Identification
Copyright
© 2005 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
