Paper 200: Osteoarthritis Incidence Ten Years After Arthroscopic ACL Reconstruction

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ABSTRACTS

the time of surgery. Postoperatively, patients were assessed for clinical instability and laxity after mean follow-up of 6.7 years (range, 5 to 8) Clinical evaluation was performed by using the modified Lysholm scoring scale and the International Knee Documentation Committee (IKDC) rating system. To assess muscle force evaluation, quadriceps strength was measured with a Tricone Isokinetic Dynanometer (Lumex Inc., Ronkonkoma, NY). One-way analysis of variance was used to determine pre-and postoperative differences for all variables. The significance level was set at P ⬍ 0.05. The clinical results for the Lysholm rating system were 91% good to excellent, while for the IKDC rating system was rated 85%. The results of the Lachman and pivot shift tests between pre-and post-operative were revealed statistically significant (P ⬍ 0.05). Eighty two of the 90 knees surveyed achieved full range of motion postoperatively. Meanwhile two patients displayed a 10° loss of full extension, three patients had a 5° to 10° loss of flexion and three patients displayed a 5° loss of full extension as compared to uninvolved knee. The anterior tibial displacement was measured with a K-T 1000 and the results were compared with the uninvolved knee, revealing nearly 90% cases less than 3 mm. The roentgenographic studies performed at follow-up exhibited degenerative change less than 15% (12 of 90 knees). Moreover, postoperative isokinetic quadriceps strength testing results comparing the two legs showed no significant difference (P ⬍ 0.05). Additionally, peak torque did not differ significantly at either 60 deg/sec or 240 deg/sec between the involved and uninvolved group. Finally, the quadriceps index indicated no significant difference in both legs. This investigation proposes that ACL reconstruction using the autogenous hamstring graft and fixation by Endobutton devices achieve good clinical outcome on 8-10 years follow-up. Paper 199: Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen Bone-Patellar-Tendon-Bone Allografts: 15-year Follow-up FLOOR VAN EIJK, MD, NETHERLANDS, PRESENTING AUTHOR W JAAP WILLEMS, MD, PHD, NETHERLANDS ABSTRACT Purpose: To evaluate the long-term outcomes following arthroscopic assisted anterior cruciate ligament (ACL) reconstruction using fresh-frozen bone-patellar-tendonbone (BPTB) allografts. Methods: Between 1991 and 1992 38 patients underwent ACL reconstruction using a BPTB allograft by a

single surgeon. The same technique was used in all operations, which consisted of the 1-incision endoscopic approach. Of these patients 31 were available for full evaluation. Evaluation included: history, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner score, physical examination, functional knee ligament testing and the International Knee Documentation Committee standard evaluation form (IKDC).Degenerative joint disease on radiographs was scored as prescribed in the x-ray section of the IKDC evaluation form. Results: The average age of the 38 patients at the time of operation was 29.2 (range 13-46) and the mean duration to follow-up was 14.5 years (range 13-16). Three patients were lost to follow-up. 29 reoperations were performed in 17 patients. Reoperations consisted of removal of the fixation material (11 patients), meniscectomy (5 patients), cyclops (2 patients), high tibial osteotomy (2 patients) or revision of the ACL (4 patients, of whom one had a total knee prosthesis afterwards), total knee prosthesis (1 patient and one was expecting one in the near future) and a diagnostic arthroscopy (4 patients). 31 of the 38 patients were available for full examination (3 patients lost to follow-up, 3 patients with a revision surgery and one with a total knee prosthesis). The mean scores for the KOOS subscales were 88.7 for Pain (⫾ 20.7), 79.3 for Symptom (⫾ 20.0), 90.5 for ADL (⫾ 18.5), 72.3 for Sport/Rec (⫾ 32.3) and 75.2 for QOL (⫾26.2). The mean Tegner score was 4.2 (⫾ 2.2). Using the IKDC evaluation score 3 patients were classified as normal (group A), 11 as nearly normal (group B), 12 as abnormal (group C) and 5 as severely abnormal (group D). 24 patients showed none or mild degenerative joint disease (group A and B). 2 patients showed moderate (group C) and 5 patients severe (group D) degenerative joint disease. Conclusion: Only 14 patients (45.2%) were classified as normal or nearly normal using the IKDC evaluation score. More than half of the patients (54.8%) required one or more re-operations and 7 patients (22.6%) showed moderate or severe degenerative joint disease. Paper 200: Osteoarthritis Incidence Ten Years After Arthroscopic ACL Reconstruction BERTRAND GALAUD, MD, FRANCE, PRESENTING AUTHOR GILLES BURDIN, FRANCE CHRISTINE LAUTRIDOU, FRANCE SÉBASTIEN EMILY, MD, FRANCE, PIERRE ABADIE, FRANCE BRUNO LOCKER, FRANCE CLAUDE VIELPEAU, FRANCE CHRISTOPHE H. HULET, MD, PROF, FRANCE BENOIT LEBEL, MD, FRANCE

ABSTRACTS ABSTRACT Introduction: During the past several decades, many changes in the management of an anterior cruciate ligament (ACL) tear have occurred, regarding the preservation of the meniscal tissue, arthroscopic techniques, and rehabilitation. Limitations of previous studies, in addition to ongoing modifications in ACL deficiency management, emphasize the need for studies with long-term follow-up to evaluate contemporary practices. The purpose of this study was to evaluate the long-term outcomes specifically regarding OA incidence following a modern management of ACL tear, including arthroscopic procedure using a bone-tendon patellar-bone auto-graft (BTPB) along with early rehabilitation. Material and Methods: An institutional prospective computerized database of ACL reconstruction was established in 1992. A case series of 101 ACL reconstructed between January 1993 and December 1994 was performed. Inclusion criteria were: reconstruction with BTPB graft, a minimum of ten years of follow-up, a standardized operative procedure and no previous ACL repair or associated ligament lesions. The meniscus status and cartilage lesions were recorded. The graft was fixed on both sides with interference metal screws. Before surgery, the mean age of patients was 28.8 year ⫹/⫺ 8.3 (mean ⫹ SD). Follow-up assessment was established with the IKDC 2000 form. Instrument testing was performed using a KT-1000 arthrometer to assess the laxity. Joint space narrowing assessment used the IKDC score with a 30° posterior anterior weight bearing view. Mean follow-up was 11.6 ⫹/⫺ 0.8 years. Results: Nine Knees (8.9%) suffered a graft rupture during the 11-year assessment period. Further meniscus surgery was performed in less than 9 % of subjects. At follow-up, the satisfaction rate was excellent (90%). Before injury, 3 patients were not involved in sport activities. Two years following ACL reconstruction, that number rose to 10 patients (10.2%). And at final follow-up, 25 patients (26.3%) either stopped or never returned to sport participation. The mean subjective IKDC 2000 score was 90.5 ⫹ 8.8 points. Kneeling was painful in 48% of patients. The subjective IKDC score was statically correlated to laxity, time from injury, and osteoarthritis. Using the full IKDC assessment for follow-up, 91 knees (90.1%) had a normal or nearly normal overall IKDC grade (graded as A or B) and ten knees (9.9%) had an abnormal grade (graded as C). The radiological assessment reported 17.8% of osteoarthritis and 39% of radiological changes. Osteoarthritis was associated with a higher pre-operative body mass index (BMI) (p ⫽ 0.01) and a higher age at follow-up (p⫽0.006). In a

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selected population without meniscus or cartilage tear, an osteoarthritis rate of only 8% was found. Conclusions: ACL reconstruction with BPTB graft and early rehabilitation offers excellent outcomes after eleven years. Moreover, a high percentage of patients remained involved in sports activities. However, knee osteoarthritis developed in 17, 8 % of subjects. Paper 201: The Prevention of Post-operative Arthrosis Following ACL Reconstruction Is Possible if Osseous Homeostasis is Restored and Maintained MAILENE CHEW, MD, USA, PRESENTING AUTHOR SCOTT F DYE, MD, USA ABSTRACT Background: Recent reports from the USA, Europe, and Asia have documented the disconcerting phenomenon of early knee arthrosis following even biomechanically well done ACL reconstructive surgery. In prior work, we have suggested that the achievement of a normal Tc 99-MDP bone scan - representing an objective marker of the restoration of osseous/joint homeostasis – following ACL reconstructive (and other) knee surgery is predictive of the absence of DJD out to 7 years. In this work, we report on 19 patients with 20 ACL reconstructed knees followed to between 10 to 15 years postoperatively both radiographically and scintigraphically. Materials and Methods: 19 patients (14 males and 5 females with a mean age of 28 - range 18 to 43 -at the time of single bundle BTB autograft reconstruction by SFD) with 20 reconstructed knees are included in this report. In addition to a history and physical examination, all patients had a Rosenberg X-ray and a standard 3 hr delayed static Tc 99MDP bone scan of the knees between 10 and 15 (mean 12.8) years post reconstruction. Results: 18/20 knees demonstrated a normal or nearly normal Rosenberg X-ray and bone scan of the involved knee. Two of the 20 knees demonstrated a positive bone scan associated with radiographic signs of degenerative arthrosis (joint space narrowing and osteophyte formation). The degree of post-operative laxity did not correlate with the absence of degenerative changes. Discussion: In prior work, we have shown that persistent loss of osseous homeostasis (manifested by positive bone scans) identifies knees “at risk” of developing early arthritis. In this work we have demonstrated in a population of ACL reconstructed knees using a single-bundle BTB autograft technique - the principle that if osseous/ joint homeostasis can be restored and maintained (currently best documented by normal bone scans) such knees can remain free of degenerative changes out to a mean of 12.8 years post-operatively. For those who may