Early versus late reconstruction for anterior cruciate ligament rupture. Results after five years of followup.
ABSTRACT We investigated the clinical and laxity testing results at 5 years' followup in patients who had early or late anterior cruciate ligament reconstruction. Twenty-three patients (Group I) were treated within 15 days of injury. Fifty-nine patients (Group II) were treated more than 3 months after injury. Patellar tendon reconstruction and fascia lata graft augmented with a ligament augmentation device were the techniques used in both groups. According to the International Knee Documentation Committee rating scale, 17 patients in Group I and 38 patients in Group II had satisfactory results. The Lysholm score was good in all Group I patients and in 55 Group II patients. Flexion-extension deficits were comparable for both groups. Eighteen patients (78%) in Group I demonstrated satisfactory results according to the KT-2000 arthrometer testing, compared with 44 (75%) in Group II. No associated lesions were present in 12 (52%) cases in Group I, compared with 26 (44%) cases in Group II. Return to sports at the preoperative level was obtained by 21 (91%) patients in Group I, compared with 42 (71%) in Group II. The patients who had reconstruction during the early phase returned to sports activities sooner and had better clinical and laxity testing results.
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ABSTRACT: Knee ligament injuries are common in sport. A rupture of the anterior cruciate ligament (ACL) is the most serious of these injuries because it may cause long term disability. In this literature review, the frequency of post-traumatic gonarthrosis is examined. There are few long term prospective studies but a number of retrospective studies with follow-up times between 5 and 20 years have been published. These studies show that radiographic gonarthrosis is significantly increased after all knee injuries compared with the uninjured joint of the same patient. Isolated meniscus rupture and subsequent repair, or partial or total ruptures of the ACL without major concomitant injuries, seem to increase the risk 10-fold (15 to 20% incidence of gonarthrosis) compared with an age-matched, uninjured population (1 to 2%). Meniscectomy in a joint with intact ligaments further doubles the risk of gonarthrosis (30 to 40%), and 50 to 70% of patients with complete ACL rupture and associated injuries have radiographic changes after 15 to 20 years. Thus, an ACL rupture combined with meniscus rupture or other knee ligament injuries results in gonarthrosis in most patients. Ten to 20 years after ACL injury, gonarthrosis often presents as a slight joint space reduction or, occasionally, joint space obliteration (Ahlbäck grades I to II), but is usually not associated with major clinical symptoms. According to the few longitudinal studies, the progress of gonarthrosis is slow, and in some cases the condition seems to remain stable. Time is an important determinant for the degree of gonarthrosis and problems demanding treatment may be encountered only at > 30 years after the initial accident.Sports Medicine 04/1999; 27(3):143-56. · 5.16 Impact Factor
Article: Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs. ligamentum patellae.[show abstract] [hide abstract]
ABSTRACT: This study compared patient outcome during the early rehabilitation phase following two different methods of anterior cruciate ligament (ACL) reconstruction: ligamentum patellae (LP) and semitendinosus/gracilis tendon (SG) based reconstruction. The study included 50 consecutive patients treated by each method, examined 6 weeks and 3, 6 and 12 months after surgery. Patients in the SG group showed significantly better Lysholm scores at 6 and 12 months, Tegner Activity Scale scores at 3 months, and pain profile assessments at 6 weeks and 3 months than those in the LP group. Significant advantages were observed in LP group in the Overall Knee Score at 6 weeks and in range-of-motion at 6 weeks and 3 and 6 months post-surgery. Stability tests revealed no significant differences between patients in the two groups. SG-based reconstruction of the ACL thus demonstrates advantages over LP-based reconstruction regarding pain and function, while LP-based reconstruction was associated with an earlier return of motion.Knee Surgery Sports Traumatology Arthroscopy 06/2004; 12(3):189-97. · 2.21 Impact Factor
Journal of Bone and Joint Surgery - British Volume 02/2003; 85(1):12-6. · 2.83 Impact Factor