Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Graft With and Without a Ligament Augmentation Device: A 25-Year Follow-up of a Prospective Randomized Controlled Trial

Marlene Mauseth Elveos; Jon Olav Drogset; Lars Engebretsen; Raymond Brønn; Trond Olav Lundemo; Tone Gifstad

doi:10.1177/2325967118808778

Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Graft With and Without a Ligament Augmentation Device: A 25-Year Follow-up of a Prospective Randomized Controlled Trial

Orthop J Sports Med. 2018 Nov 20;6(11):2325967118808778. doi: 10.1177/2325967118808778. eCollection 2018 Nov.

Authors

Marlene Mauseth Elveos¹, Jon Olav Drogset^{1

2}, Lars Engebretsen^{3

4}, Raymond Brønn⁵, Trond Olav Lundemo^{1

2}, Tone Gifstad^{1

2}

Affiliations

¹ Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
² Orthopaedic Research Center, Trondheim University Hospital, Trondheim, Norway.
³ Orthopaedic Center, Oslo University Hospital, Oslo, Norway.
⁴ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ Aleris Radiology Center Trondheim, Trondheim, Norway.

Abstract

Background: Various grafts and ligament augmentation devices (LADs) have been used in the search for optimal reconstruction of the anterior cruciate ligament (ACL).

Purpose: To compare 25-year follow-up results after ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft with or without the Kennedy LAD.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: One hundred patients undergoing ACL reconstruction between 1991 and 1993 were randomized into 2 groups: reconstruction using a BPTB graft alone (BPTB group, 51 patients) or a BPTB graft with the Kennedy LAD (LAD group, 49 patients). The 25-year follow-up evaluation included a clinical knee examination, patient-reported outcome measures, and an assessment of radiological osteoarthritis (OA) according to the Ahlbäck classification. Additional outcomes were reruptures and knee arthroplasty.

Results: Ninety-three patients (93%) were available for the follow-up evaluation: 48 patients in the BPTB group and 45 in the LAD group. Through telephone calls, 26 patients were excluded from further investigation because of reruptures and arthroplasty in the knee of interest; 67 patients were further investigated. A total of 43 of 44 (98%) and 42 of 44 (95%) patients had negative or 1+ Lachman and pivot-shift test results, respectively. The mean Lysholm score was 85 for the BPTB group and 83 for the LAD group. All mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values were ≥73. There were no statistically significant differences between groups in any of these outcomes or regarding the Tegner score, radiological classification of OA, or number of ACL reruptures. Signs of radiological OA were detected in all patients, and severe radiological OA (Ahlbäck grade III, IV, or V) was detected in 32% of patients in the BPTB group and 21% of patients in the LAD group (P = .37). There were 12 patients in the BPTB group and 7 in the LAD group who had documented reruptures (P = .40). One patient in the BPTB group and 6 in the LAD group underwent knee arthroplasty (P = .054).

Conclusion: In the present study, there were no statistically significant differences between groups in any of the outcomes. After 25 years, 19% of patients had reruptures, 27% had severe radiological OA, and 7% underwent knee arthroplasty.

Keywords: aging athlete; anterior cruciate ligament; biology of ligament; knee ligaments; ligament augmentation device.