Background: There is limited evidence on long-term outcome following ACL reconstruction. Concern has been raised that degenerative joint disease is common in the long-term and this may be associated with use of patellar tendon autograft.

Methods: 162 patients underwent single-surgeon arthroscopic ACL reconstruction (1991–1993) were identified from our prospective database. Patient-centred outcome was by Lysholm and Subjective IKDC score, objective outcome measures were clinical examination, arthrometry and X-rays.

Results: 13 year outcome (10–15 years) is known in 115/161 patients (71%). The median subjective scores were 94% (Lysholm) and 90% (IKDC). Ipsilateral graft rupture rate was 4%, with contralateral ACL injury in 8%. Mean manual maximum KT 1000 was 9mm in the grafted knee and 8mm in the contralateral knee. Clinical laxity scores of grade 0 or 1 were found in over 93% patients. Radiographically 66% were normal or near normal (Grade A or B). When compared to the contra-lateral uninjured knee we found no significant difference in the proportion of normal/near normal x-rays (grade A/B) versus abnormal/severe (grade C/D) for the medial, lateral nor patellofemoral compartments. There was no significant difference in the radiological IKDC grades in the medial compartment when compared to the contra-lateral uninjured knee, but there was a difference in the lateral and patellofemoral joints.

Conclusions: At 13 years patellar tendon ACLR provides excellent patient satisfaction, with clinically objective knee stability and low risk of re-rupture. Radiographically degenerative change was seen in 34%. There was no significant side to side difference to the uninjured contralateral medial knee joint, but there was a small but significant difference in the lateral and patellofemoral joints. The lateral joint differences may reflect underlying bone bruising at the time of injury. We do not believe that the patellar tendon autograft is the cause of arthrosis after BTB ACLR.