The Journal of Bone and Joint Surgery 78:159-69 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.
A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients*
TORBJØRN GRØNTVEDT, M.D. ,
LARS ENGEBRETSEN, M.D., PH.D. ,
PÅL BENUM, M.D., PH.D., TRONDHEIM,
OVE FASTING, M.D. , OSLO,
ANDERS MØLSTER, M.D., PH.D.¶ and
TORBJØRN STRAND, M.D.¶, BERGEN, NORWAY
Investigation performed at the Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim; the Department of Orthopaedic Surgery, Aker Hospital, University of Oslo, Oslo; and the Department of Orthopaedic Surgery, Haukeland Hospital, University of Bergen, Bergen
A five-year, prospective, randomized follow-up study was done to compare three methods for repair of a rupture of the anterior cruciate ligament of the knee: acute primary repair (Group 1), acute repair with a synthetic ligament-augmentation device (Group 2), and acute repair augmented with an autologous bone-patellar ligament-bone graft (Group 3). One hundred and fifty patients who had an acute rupture of the anterior cruciate ligament were randomized to one of the three repair groups, with fifty patients in each group. The patients were between sixteen and fifty years old (mean, twenty-nine years old). All patients had the operation within ten days after the injury. The rehabilitation protocol was identical for each group. The patients were evaluated prospectively at one, two, and five years with use of the Tegner scoring system for level of activity and the scoring system of Lysholm and Gillquist for function, and the stability of the knee was assessed with clinical examination and with use of the KT-1000 arthrometer. One hundred and thirty-one patients completed the study and ten other patients were known to have had a failure of the procedure, a 94 per cent rate of follow-up.
All three groups had a lower level of activity at the five-year follow-up evaluation than they had had before the injury. The patients who had had augmentation with a patellar-ligament graft had a significantly higher mean level of activity at two years than those who had had non-augmented repair (p = 0.002) and those who had had repair with a synthetic ligament-augmentation device (p = 0.01). They also had a significantly higher mean level of function at two years than those who had had non-augmented repair (p = 0.0001) and those who had had repair with a synthetic ligament-augmentation device (p = 0.03) and a significantly higher mean level of function at five years than those who had had non-augmented repair (p = 0.004). The ability to attain full extension improved significantly in all three groups during the five-year follow-up period; the highest gains occurred in the group that had had augmentation with a patellar-ligament graft.
Rotatory and anterior instability progressively increased during the follow-up period for all three groups. At one, two, and five years, the knees that had had repair with a patellar-ligament graft were significantly more stable than those that had had non-augmented repair and those that had had repair with a ligament-augmentation device (p < 0.0001 to p = 0.03).
The findings of this study reinforce the conclusions of our two-year follow-up report that a non-augmented primary repair should not be performed, a repair with a ligament-augmentation device has an unacceptably high rate of failure (more than one-third of the patients), and a repair that is augmented with the patellar ligament has the best outcome.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
M. E. Steiner, M. M. Murray, and S. A. Rodeo
Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement
Am. J. Sports Med.,
January 1, 2008;
36(1):
176 - 189.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. S. Lohmander, P. M. Englund, L. L. Dahl, and E. M. Roos
The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries: Osteoarthritis
Am. J. Sports Med.,
October 1, 2007;
35(10):
1756 - 1769.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. O. Drogset, T. Grontvedt, and G. Myhr
Magnetic Resonance Imaging Analysis of Bioabsorbable Interference Screws Used for Fixation of Bone-Patellar Tendon-Bone Autografts in Endoscopic Reconstruction of the Anterior Cruciate Ligament
Am. J. Sports Med.,
July 1, 2006;
34(7):
1164 - 1169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. O. Drogset, T. Grontvedt, O. R. Robak, A. Molster, A. T. Viset, and L. Engebretsen
A Sixteen-Year Follow-up of Three Operative Techniques for the Treatment of Acute Ruptures of the Anterior Cruciate Ligament
J. Bone Joint Surg. Am.,
May 1, 2006;
88(5):
944 - 952.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. D. Beynnon, R. J. Johnson, J. A. Abate, B. C. Fleming, and C. E. Nichols
Treatment of Anterior Cruciate Ligament Injuries, Part I
Am. J. Sports Med.,
October 1, 2005;
33(10):
1579 - 1602.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. P. Spindler, T. A. Warren, J. C. Callison Jr., M. Secic, S. B. Fleisch, and R. W. Wright
Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament
J. Bone Joint Surg. Am.,
August 1, 2005;
87(8):
1673 - 1679.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Harvey, N. P. Thomas, and A. A. Amis
Fixation of the graft in reconstruction of the anterior cruciate ligament
J Bone Joint Surg Br,
May 1, 2005;
87-B(5):
593 - 603.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Myklebust, I. Holm, S. Maehlum, L. Engebretsen, and R. Bahr
Clinical, Functional, and Radiologic Outcome in Team Handball Players 6 to 11 Years after Anterior Cruciate Ligament Injury: A Follow-up Study
Am. J. Sports Med.,
November 1, 2003;
31(6):
981 - 989.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. K. Aune, I. Holm, M. A. Risberg, H. K. Jensen, and H. Steen
Four-Strand Hamstring Tendon Autograft Compared with Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction: A Randomized Study with Two-Year Follow-Up
Am. J. Sports Med.,
November 1, 2001;
29(6):
722 - 728.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Bowditch
Anterior cruciate ligament rupture and management
Trauma,
October 1, 2001;
3(4):
249 - 261.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. H. Fu, C. H. Bennett, C. B. Ma, J. Menetrey, and C. Lattermann
Current Trends in Anterior Cruciate Ligament Reconstruction: Part II. Operative Procedures and Clinical Correlations
Am. J. Sports Med.,
January 1, 2000;
28(1):
124 - 130.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. S. Corry, J. M. Webb, A. J. Clingeleffer, and L. A. Pinczewski
Arthroscopic Reconstruction of the Anterior Cruciate Ligament: A Comparison of Patellar Tendon Autograft and Four-Strand Hamstring Tendon Autograft
Am. J. Sports Med.,
July 1, 1999;
27(4):
444 - 454.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Barber-Westin, F. R. Noyes, T. P. Heckmann, and B. L. Shaffer
The Effect of Exercise and Rehabilitation on Anterior-Posterior Knee Displacements After Anterior Cruciate Ligament Autograft Reconstruction
Am. J. Sports Med.,
January 1, 1999;
27(1):
84 - 93.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Maffulli and C. R. Clark
Correspondence
J. Bone Joint Surg. Am.,
June 1, 1998;
80(6):
923 - 923.
[Full Text]
|
|
|
|
|
|
|
C. B. FRANK and D. W. JACKSON
Current Concepts Review - The Science of Reconstruction of the Anterior Cruciate Ligament
J. Bone Joint Surg. Am.,
October 1, 1997;
79(10):
1556 - 76.
[Full Text]
|
|
|
|
