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Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients

Journal article
Authors Gauti Laxdal
Jüri Kartus
L. Ejerhed
Ninni Sernert
Lennart Magnusson
Eva Faxén
Jón Karlsson
Published in Arthroscopy
Volume 21
Issue 8
Pages 958-964
ISSN 1526-3231
Publication year 2005
Published at Institute of Surgical Sciences, Department of Orthopaedics
Pages 958-964
Language en
Keywords Adolescent, Adult, Anterior Cruciate Ligament/*surgery, *Arthroscopy, Bone Screws, Cohort Studies, Female, Femoral Fractures/epidemiology/surgery, Femur/surgery/*transplantation, Follow-Up Studies, Humans, Knee Injuries/epidemiology, Male, Middle Aged, Patellar Ligament/injuries/*transplantation, Recurrence, Retrospective Studies, Risk Factors, Rupture/epidemiology/surgery, Severity of Illness Index, Tendons/surgery/*transplantation, Tibia/surgery/*transplantation, Tibial Fractures/epidemiology/surgery, Time Factors, Transplantation, Autologous, Treatment Outcome
Subject categories Orthopaedics


PURPOSE: The aim of the study was to assess the outcome and risk factors after anterior cruciate ligament (ACL) reconstruction in a large group of patients. TYPE OF STUDY: Case series. METHODS: Included in this retrospective study were 948 patients (323 female, 625 male) with a symptomatic unilateral ACL rupture, who underwent arthroscopic reconstruction using patellar tendon autograft and interference screw fixation at 3 Swedish hospitals. The median age of the patients at the time of the index operation was 26 years (range, 14 to 53 years). The patients underwent surgery at a median of 12 months (range, 0.5 to 360 months) after their injury. Independent physiotherapists performed the follow-up examinations at a median of 32 months (range, 21 to 117 months) postoperatively. RESULTS: Of the 948 patients, 550 (58%) underwent meniscal surgery before, during, or after the ACL reconstruction. The median Tegner activity level was 8 (range, 2-10) before injury, 3 (range, 0-9) preoperatively, and 6 (range, 1-10) at follow-up (P < .0001 preoperative v follow-up). At follow-up, the median Lysholm score was 90 points (range, 14-100), the median KT-1000 anterior side-to-side laxity difference was 1.5 mm (range, -6 to 13 mm), and the median 1-leg hop test quotient was 95% (0% to 167%) compared with the contralateral normal side. At follow-up, 69.3% of the patients were classified as normal or nearly normal according to the International Knee Documentation Committee evaluation system. However, 36% of the patients were unable to or had severe problems performing the knee-walking test. Inferior results correlated with increased time period between the index injury and reconstruction and concomitant joint damage found at the index operation. CONCLUSIONS: Overall, the results were good after ACL reconstruction using patellar tendon autograft and interference screw fixation. Concomitant joint damage and a long time period between the injury and reconstruction are major risk factors for inferior outcome after ACL reconstruction. LEVEL OF EVIDENCE: Level IV, case series.

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