Dr. Shelbourne
Dr. Urch
Research
| What can I expect 10 years after my ACL reconstruction? Is there anything I can do to improve my outcome? We recently completed a study of our ACL patients who had their surgery at least 10 years ago. One of the main findings of this study was that patients who maintained full range of motion had better results. In fact, range of motion loss was the main factor relating to lower scores/results. |
The study featured on this page is available upon request.
Minimum 10-Year Results after Anterior Cruciate Ligament Reconstruction: How the Loss of Normal Knee Motion Compounds Other Factors Related to the Development of Osteoarthritis after Surgery.
K. Donald Shelbourne, MD, Tinker Gray, MA
Introduction
There are very few studies reporting the results of ACL reconstruction at 10 years or more after surgery. Some studies have shown that patients who have meniscus loss, articular cartilage damage, or both have lower subjective scores and a higher likelihood of developing arthritis when compared to patients who have very little joint damage at the time of ACL reconstruction.
Few studies have examined how the loss of range of motion (ROM) affects the long-term results of ACL reconstruction. A recent study was conducted by K. Donald Shelbourne, MD to examine how the loss of normal knee hyperextension (straightening), flexion (bending), or both affected the results of ACL reconstruction at longer than 10-year follow-up. This study also examined the impact of damage to the meniscus and articular cartilage on the long-term results. This report will summarize the findings of this scientific study of over 500 patients who had ACL reconstruction surgery at least 10 years ago.
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Methods of the study:
The study group included patients who underwent ACL reconstruction with an ipsilateral (same knee) patellar tendon graft between 1982 and 1994. Data were collected prospectively to evaluate ROM, strength, stability, x-ray evidence of arthritis, and performance on surveys assessing knee function. ROM was compared to the opposite knee according to the International Knee Documentation Committee (IKDC) criteria. Extension ROM was considered normal if it was within 2 degrees of the normal knee, and flexion ROM was considered normal if it was within 5 degrees of the normal knee. 502 patients returned for follow-up at an average of 14.1 years after surgery and were included in this study.
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Results:
Most patients had normal range of motion, but there were significant differences in the results when comparing these patients to the group with less than normal ROM. Patients with less than normal ROM had lower average x-ray gradings, subjective survey scores, and strength scores when compared to the group of patients with normal ROM.
74% of patients had normal knee ROM at follow-up. 10% of patients demonstrated loss of normal extension alone, 10% of patients demonstrated loss of normal flexion alone, and 6% of patients demonstrated loss of both extension and flexion ROM.
The number of patients with abnormal x-rays was significantly higher in the group of patients with less than normal ROM. Of the 502 patients in the study, 300 had completely normal x-rays. In the group of 202 patients with less than normal x-rays, 43% of them had less than normal knee extension or flexion ROM. In contrast, in the group of 300 patients with normal x-rays, only 14% had less than normal knee extension or flexion ROM.
Patients who had normal knee extension and flexion had significantly higher IKDC subjective survey scores than patients who lacked knee range of motion (P < .001).
Mean IKDC Subjective Survey Scores Based on KneeRange of Motion |
|
Normal extension/normal flexion |
86.4 |
Normal extension/less than normal flexion |
79.6 |
Less than normal extension/normal flexion |
78.1 |
Less than normal extension/less than normal flexion |
68.7 |
*Note: Maximum IKDC score = 100
When looking at the group of patients who had intact menisci, normal articular cartilage, and normal knee extension and flexion ROM, only 1.9% had less than normal x-rays. Patients who had meniscectomy (removal of a portion of the meniscus) or articular cartilage damage had significantly lower IKDC subjective survey scores IF they also had less than normal ROM.
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Conclusions:
- At an average of 14.1 years after ACL reconstruction, 90% of patients had an overall grade of normal or nearly normal.
- Even a slight ROM deficit can cause adverse symptoms, especially when other damage is present in the knee
- Patients who had normal extension and flexion ROM had significantly better survey scores than patients who had ROM loss
- There is an association between range of motion loss and arthritic changes in the knee
Patients who had a loss of ROM had worse results and more x-ray evidence of arthritis. Almost all patients (98%) who had intact menisci, normal articular cartilage, and normal knee extension and flexion had normal x-rays at follow-up. Although the surgeon and patient cannot control the damage sustained to the knee joint after ACL injury, results following ACL reconstruction can be maximized by ensuring that full ROM is achieved and maintained.