The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions: A Linkage Study with the Norwegian Arthroplasty Register, 1999 to 2020

Background: Focal cartilage lesions are common in the knee. The risk of later ipsilateral knee arthroplasty remains unknown. The purposes of the present study were to evaluate the long-term cumulative risk of knee arthroplasty after arthroscopic identification of focal cartilage lesions in the knee, to investigate the risk factors for subsequent knee arthroplasty, and to estimate the subsequent cumulative risk of knee arthroplasty compared with that in the general population. Methods: Patients who had undergone surgical treatment of focal cartilage lesions at 6 major Norwegian hospitals between 1999 and 2012 were identified. The inclusion criteria were an arthroscopically classified focal cartilage lesion in the knee, an age of ≥18 years at the time of surgery, and available preoperative patient-reported outcomes (PROMs). The exclusion criteria were osteoarthritis or “kissing lesions” at the time of surgery. Demographic data, later knee surgery, and PROMs were collected with use of a questionnaire. A Cox regression model was used to adjust for and investigate the impact of risk factors, and Kaplan-Meier analysis was performed to estimate cumulative risk. The risk of knee arthroplasty in the present cohort was compared with that in the age-matched general Norwegian population. Results: Of the 516 patients who were eligible, 322 patients (328 knees) consented to participate. The mean age at the time of the index procedure was 36.8 years, and the mean duration of follow-up was 19.8 years. The 20-year cumulative risk of knee arthroplasty in the cartilage cohort was 19.1% (95% CI, 14.6% to 23.6%). Variables that had an impact on the risk of knee arthroplasty included an ICRS grade of 3 to 4 (hazard ratio [HR], 3.1; 95% CI, 1.1 to 8.7), an age of ≥40 years at time of cartilage surgery (HR, 3.7; 95% CI, 1.8 to 7.7), a BMI of 25 to 29 kg/m2 (HR, 3.9; 95% CI, 1.7 to 9.0), a BMI of ≥30 kg/m2 (HR, 5.9; 95% CI, 2.4 to 14.3) at the time of follow-up, autologous chondrocyte implantation (ACI) at the time of the index procedure (HR, 3.4; 95% CI, 1.0 to 11.4), >1 focal cartilage lesion (HR, 2.1; 95% CI, 1.1 to 3.7), and a high preoperative visual analog scale (VAS) score for pain at the time of the index procedure (HR, 1.1; 95% CI, 1.0 to 1.1). The risk ratio of later knee arthroplasty in the cartilage cohort as compared with the age-matched general Norwegian population was 415.7 (95% CI, 168.8 to 1,023.5) in the 30 to 39-year age group. Conclusions: In the present study, we found that the 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19%. Deep lesions, higher age at the time of cartilage surgery, high BMI at the time of follow-up, ACI, and >1 cartilage lesion were associated with a higher risk of knee arthroplasty.publishedVersio

Results after surgical treatment of anterior cruciate ligament injuries - A clinical study

dr.med.dr.med

Autologous BPTB ACL Reconstruction Results in Lower Failure Rates Than ACL Repair with and without Synthetic Augmentation at 30 Years of Follow-up

Background: The aim of this study was to compare the 30-year follow-up results after treatment of anterior cruciate ligament (ACL) ruptures with 3 different surgical procedures. Methods: A total of 150 patients with acute rupture of the ACL who were managed between 1986 and 1988 were randomized into 1 of 3 open repair methods: acute primary repair (n = 49), acute repair with a synthetic ligament augmentation device (LAD) (n = 50), or reconstruction with an autologous bone-patellar tendon-bone (BPTB) graft with retention of the ACL remnants (n = 51). The 30-year follow-up included evaluation of clinical findings, the Tegner and Lysholm questionnaires, radiographic examination, and registration of revisions and knee arthroplasties. Results: A total of 113 patients (75%) were available for the follow-up evaluation; 39 patients were in the primary repair group, 39 in the LAD group, and 35 in the BPTB group. Through telephone calls and investigation of patient medical records, 40 of these patients were excluded from further analyses because of revision surgery, knee arthroplasty in the involved or contralateral knee, or ACL reconstruction in the contralateral knee. One patient in the BPTB group had undergone revision ACL reconstruction compared with 12 in the primary repair group (p = 0.002) and 9 in the LAD group (p = 0.015). Seven patients had undergone knee arthroplasty in the involved knee, with no significant difference among the groups. In the remaining patients, no significant differences were found among the 3 groups with regard to range of motion, laxity, or Tegner and Lysholm scores. Radiographic evidence of osteoarthritis, defined as an Ahlbäck grade of 2 through 5, was found in 42% of the operatively treated knees, with no significant differences among the groups. Conclusions: In the present 30-year follow-up results of a randomized controlled study, the BPTB graft augmented with the remnants of the ruptured ligament provided superior results with regard to the number of revisions compared with both the primary repair and LAD groups. No significant differences were found with respect to range of motion, laxity, activity, function, radiographic evidence of osteoarthritis, and knee arthroplasties. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence

Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Graft With and Without a Ligament Augmentation Device: A 25-Year Follow-up of a Prospective Randomized Controlled Trial.

Background: Various grafts and ligament augmentation devices (LADs) have been used in the search for optimal reconstruction of the anterior cruciate ligament (ACL). Purpose: To compare 25-year follow-up results after ACL reconstruction using a bone–patellar tendon–bone (BPTB) graft with or without the Kennedy LAD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: One hundred patients undergoing ACL reconstruction between 1991 and 1993 were randomized into 2 groups: reconstruction using a BPTB graft alone (BPTB group, 51 patients) or a BPTB graft with the Kennedy LAD (LAD group, 49 patients). The 25-year follow-up evaluation included a clinical knee examination, patient-reported outcome measures, and an assessment of radiological osteoarthritis (OA) according to the Ahlbäck classification. Additional outcomes were reruptures and knee arthroplasty. Results: Ninety-three patients (93%) were available for the follow-up evaluation: 48 patients in the BPTB group and 45 in the LAD group. Through telephone calls, 26 patients were excluded from further investigation because of reruptures and arthroplasty in the knee of interest; 67 patients were further investigated. A total of 43 of 44 (98%) and 42 of 44 (95%) patients had negative or 1+ Lachman and pivot-shift test results, respectively. The mean Lysholm score was 85 for the BPTB group and 83 for the LAD group. All mean Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values were ≥73. There were no statistically significant differences between groups in any of these outcomes or regarding the Tegner score, radiological classification of OA, or number of ACL reruptures. Signs of radiological OA were detected in all patients, and severe radiological OA (Ahlbäck grade III, IV, or V) was detected in 32% of patients in the BPTB group and 21% of patients in the LAD group (P = .37). There were 12 patients in the BPTB group and 7 in the LAD group who had documented reruptures (P = .40). One patient in the BPTB group and 6 in the LAD group underwent knee arthroplasty (P = .054). Conclusion: In the present study, there were no statistically significant differences between groups in any of the outcomes. After 25 years, 19% of patients had reruptures, 27% had severe radiological OA, and 7% underwent knee arthroplasty

Autologous BPTB ACL Reconstruction Results in Lower Failure Rates Than ACL Repair with and without Synthetic Augmentation at 30 Years of Follow-up

Background: The aim of this study was to compare the 30-year follow-up results after treatment of anterior cruciate ligament (ACL) ruptures with 3 different surgical procedures. Methods: A total of 150 patients with acute rupture of the ACL who were managed between 1986 and 1988 were randomized into 1 of 3 open repair methods: acute primary repair (n = 49), acute repair with a synthetic ligament augmentation device (LAD) (n = 50), or reconstruction with an autologous bone-patellar tendon-bone (BPTB) graft with retention of the ACL remnants (n = 51). The 30-year follow-up included evaluation of clinical findings, the Tegner and Lysholm questionnaires, radiographic examination, and registration of revisions and knee arthroplasties. Results: A total of 113 patients (75%) were available for the follow-up evaluation; 39 patients were in the primary repair group, 39 in the LAD group, and 35 in the BPTB group. Through telephone calls and investigation of patient medical records, 40 of these patients were excluded from further analyses because of revision surgery, knee arthroplasty in the involved or contralateral knee, or ACL reconstruction in the contralateral knee. One patient in the BPTB group had undergone revision ACL reconstruction compared with 12 in the primary repair group (p = 0.002) and 9 in the LAD group (p = 0.015). Seven patients had undergone knee arthroplasty in the involved knee, with no significant difference among the groups. In the remaining patients, no significant differences were found among the 3 groups with regard to range of motion, laxity, or Tegner and Lysholm scores. Radiographic evidence of osteoarthritis, defined as an Ahlbäck grade of 2 through 5, was found in 42% of the operatively treated knees, with no significant differences among the groups. Conclusions: In the present 30-year follow-up results of a randomized controlled study, the BPTB graft augmented with the remnants of the ruptured ligament provided superior results with regard to the number of revisions compared with both the primary repair and LAD groups. No significant differences were found with respect to range of motion, laxity, activity, function, radiographic evidence of osteoarthritis, and knee arthroplasties