The prevalence of osteoarthritis was comparable in patients undergoing anterior cruciate ligament reconstruction using either bone-patellar tendon-bone or hamstring tendon autografts, according to a retrospective study.
The presence of meniscal injuries, however, increased the prevalence of osteoarthritis (OA), the researchers said.
A total of 113 patients at a single institution who had symptomatic unilateral chronic anterior cruciate (ACL) reconstruction between April 1995 and May 1998 as part of three prospective randomized studies and who were available for follow-up were examined, according to Dr. Mattias Lidén and colleagues from the Sahlgrenska University Hospital, Göteborg, Sweden.
Ipsilateral bone-patellar tendon-bone (BPTB) autografts were used for reconstruction in 72 patients; the remaining 41 patients, referred to as the hamstring tendon autograft (HT) group, had reconstruction with either ipsilateral triple semitendinosus autografts (32) or quadruple semitendinous autografts (9).
The patients' median age was 28 years at the time of surgery, which was performed at a median of 18 months after injury. There were 49 men in the BPTB group and 29 in HT group. Most of the injuries were caused by contact sports (71%) and noncontact sports (15%), with no significant difference in degree of injury between sources of injury. Meniscal injuries were present in 69% of the BPTB group and in 68% of the HT group.
A single surgeon performed the procedures, in which fixation of both types of graft was done using interference screws. After standard rehabilitation, patients who attained full functional stability were permitted to resume running at 3 months and contact sports at 6 months.
Standard radiographic follow-up, performed according to the rating systems of Ahlbäck and Fairbank, was interpreted by a radiologist blinded to the type of graft used. Independent physiotherapists not involved in the rehabilitation process assessed patients pre- and postoperatively. The follow-up radiographic and clinical assessments were made at a median of 86 months after reconstruction (Arthroscopy 2008;24:899–908).
There was no significant radiological difference between the BPTB and HT groups with respect to osteoarthritis, according to radiological assessments. Overall, OA was found in 23% of patients, according to the Ahlbäck rating system (25% of BPTB and 20% of HT), and in 74% of patients, according to the Fairbank rating system (76% in the BPTB and 71% in the HT groups). However, patients with meniscal injuries treated before, during, or after the index operation had significantly more OA findings in both systems than did patients without such injuries, the authors stated.
On the basis of the slight yet significant correlation between time of injury to reconstruction and the cumulative number of positive Fairbank changes, the authors said patients should undergo reconstruction as soon as possible after injury to minimize future meniscal injuries and the development of OA.