PATELLAR TENDON LIGAMENTOPLASTY FOR ANTERIOR CRUCIATE LIGAMENT TEARS: COMPARISON OF TEN YEAR OUTCOME IN PATIENTS OPERATED IN AN ACUTE SETTING OR FOR CHRONIC LESIONS

Abstract

Purpose: The purpose of this study was to compare, at ten years follow-up, the clinical and radiological results obtained in two series of patients who underwent patellar tendon ligmentoplasty for anterior cruciate ligament tears. One series was operated in an acute setting (before 45 days) and the other for chronic lesions.

Material and methods: In 1986 and 1987, we performed patellar ligamentoplasty for anterior cruciate ligament tears in 230 knees. Mean delay to surgery was ten days for 77 knees (53 reviewed with clinical and radiological evaluation and 12 with questionnaires, i.e. 84%). For 153 knees surgery was performed for chronic lesions (107 reviewed with clinical and radiological evaluation and 12 with questionnaires, i.e. 77%). The IKDC chart was used to assess outcome with KT 2000 measurements on the loaded images.

Results: There was a significant difference between the two series for: overt meniscal tears at the time of surgery (58% in the chronic series and 11% in the acute series, p < < 1%); osteoarthritic (26% chronic versus 6% acute, p < 1%); overall IKDC score (96% for acute versus 84% for chronic, p < 3%). The same was true for subjective assessment (normal for 95% of the acute knees versus 65% for the chronic knees) and for rate of recurrent tears (2% for acute and 9% for chronic). There was no significant difference between the series for clinical signs (pain, swelling, apprehension), mean residual laxity as measured by KT 2000, although it was greater for the chronic knees (+2.6%) than for the acute knees (+2.3%). Permanent flexion was not significantly different between the series (31% for chronic and 28% for acute) although the reason was different since for the chronic series, subsequent meniscectomy was necessary.

Conclusion: Patellar ligamentoplasty performed in an acute setting provides better clinical and radiological outcome. It stabilises the knee better before possible development of a meniscal lesion that may precipitate osteoarthritis.