The Journal of Bone and Joint Surgery (American) 83:1329-1332 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Arthroscopically Assisted Reconstruction of the Anterior Cruciate Ligament
A Follow-up Report
Daniel B. O'Neill, MD
Investigation performed at Christus St. John Sports Medicine Center,
Nassau Bay, Texas
Daniel B. O’Neill, MD
Christus St. John Sports Medicine Center, 18100 St. John Drive,
Suite 300, Nassau Bay, TX 77058
In support of this research or preparation of this manuscript, the
author received grants or outside funding from Dyonics and from
Mitek. The author did not receive payments or other benefits or
a commitment or agreement to provide such benefits from a commercial
entity. No commercial entity paid or directed, or agreed to pay
or direct, any benefits to any research fund, foundation, educational
institution, or other charitable or nonprofit organization with
which the author is affiliated or associated.
A video supplement to this article is available from the Video Journal
of Orthopaedics. A video clip is available at the JBJS web site,
www.jbjs.org. The Video Journal of Orthopaedics can be contacted
at (805) 962-3410, web site: www.vjortho.com.
Background: The purpose of this study was to
further delineate the outcome of arthroscopically assisted anterior
cruciate ligament reconstruction in 125 patients who had previously
been followed for two to five years. One of the original 125 patients was
excluded from the present study because of insufficient follow-up,
and an additional group of 101 patients was added. All 225 patients
in the present study were followed for a minimum of six years.
Methods: Patients were randomly assigned to reconstruction
with a double-stranded semitendinosus-gracilis graft with use of
a two-incision technique (group I), reconstruction with
a patellar ligament graft with use of a two-incision technique
(group II), or reconstruction with a patellar ligament graft with
use of a single-incision endoscopic technique (group III).
The groups were compared with regard to the rate of graft failure, the
amount of instability, knee strength, radiographic signs of degenerative
changes, and functional outcome.
Results: There was no significant difference among
the three groups with regard to the rate of graft failure, the amount
of knee instability, or the functional outcome. A normal or nearly
normal functional outcome was recorded for 208 (92%) of
the 225 patients. There were significant differences among the groups
with regard to quadriceps muscle-strength deficits: group I had
fewer patients with deficits than group III, and groups I and III
both had fewer patients with deficits than group II (p = 0.04).
There also were significant differences among the groups with regard
to hamstring muscle-strength deficits: group III had fewer patients
with deficits than group II, and group II had fewer patients with
deficits than group I (p < 0.01). Twelve knees (16%)
in group I, six knees (8%) in group II, and eight knees
(11%) in group III showed radiographic evidence of progressive
degenerative changes, but the differences among the three groups
were not significant.
Conclusion: Although 11.6% of the 225 knees
had radiographic evidence of degenerative arthritis at a minimum
of six years after arthroscopically assisted reconstruction of the
anterior cruciate ligament, the choice of graft and the technique
of reconstruction did not seem to affect the rate of development
of these changes.
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