gms | German Medical Science

Objectives: The material choice for anterior cruciate ligament (ACL) reconstruction remains debated. It is generally accepted that the short- to mid-term results are independent from the material used (except for ligament prostheses). The goal of this study was to collect all published date about the long term results (more than 10 years) after ACL reconstruction according to the material used for reconstruction.

Methods: A comprehensive research was performed on the Pubmed database. 3,536 cases from 44 papers were extracted. The classical criteria for results evaluation have been analyzed according to the material used for ACL reconstruction.

Results: 6 different materials have been used: bone-patellar tendon-bone (1920 cases), bone-patellar tendon-bone and anterolateral plasty (481 cases), hamstring tendons (468 cases), hamstring tendons and anterolateral plasty (81 cases), intra- and extra-articular fascia late (236 cases), ligament prosthesis (68 cases); 3 papers (282 cases) reported about different materials. Mean follow-up time was 12 years (range, 10 to 25 years).

74% of the cases were classified as having a A ou B subjective IKDC score; the highest scores were observed after pure intra-articular reconstruction, the lowest after prosthetic reconstruction. The mean Lysholm score was 90/100; the highest scores were observed after intra-articular reconstruction and anterolateral plasty, the lowest after prosthetic reconstruction. 45% of the cases were able to recover their previous sport level; the highest rates were observed after hamstring intra-articular reconstruction, the lowest after prosthetic reconstruction. 74% of the cases had a differential laxity less than 3 mm; there was no difference between all materials but prostheses. 21% of the cases had radiographic evidence of osteoarthritis; the lowest rate was after hamstring reconstruction, the highest after prosthetic reconstruction. 6% of the cases experienced a repeat failure; the lowest rate was after intra- and extra-articular reconstruction, the highest after prosthetic reconstruction.

Discussion: The well documented good short to mid-term results after ACL reconstruction may last more than 10 years. The rate of repeat rupture is low and should be compared with the known complications of conservative treatment. The incidence of osteoarthritis is significant among this rather young population. It is questionable if this incidence might be compensated by more frequent and earlier ACL reconstruction, especially before meniscal damage occurred, and by performing meniscal suture instead of meniscectomy. There is no evidence than any autologous material should be preferred, but prosthetic reconstruction should be abandoned.