The aim of this study was to investigate the long-term clinical
and radiological outcome of patients who suffer recurrent injuries
to the anterior cruciate ligament (ACL) after reconstruction and
require revision surgery. From a consecutive series of 200 patients who underwent primary
reconstruction following rupture of the ACL, we identified 36 who
sustained a further rupture, 29 of whom underwent revision surgery.
Patients were reviewed prospectively at one, two, seven, 15 and
about 20 years after their original surgery. Primary outcome measures
were the number of further ruptures, the posterior tibial slope
(PTS), and functional and radiological outcomes. These were compared
with a gender and age matched cohort of patients who underwent primary
ACL reconstruction only.Aims
Patients and Methods
The aim of this study was to examine the functional
outcome at ten years following lateral closing wedge high tibial osteotomy
for medial compartment osteoarthritis of the knee and to define
pre-operative predictors of survival and determinants of functional
outcome. 164 consecutive patients underwent high tibial osteotomy between
2000 and 2002. A total of 100 patients (100 knees) met the inclusion
criteria and 95 were available for review at ten years. Data were
collected prospectively and included patient demographics, surgical
details, long leg alignment radiographs, Western Ontario and McMaster Universities
osteoarthritis index (WOMAC) and Knee Society scores (KSS) pre-operatively
and at five and ten years follow-up. At ten years, 21 patients had been revised at a mean of five
years. Overall Kaplan–Meier survival was 87% (95% confidence interval
(CI) 81 to 94) and 79% (95% CI 71 to 87) at five and ten years,
respectively. When compared with unrevised patients, those who had
been revised had significantly lower mean pre-operative WOMAC Scores
(47 (21 to 85) This study has shown that improved survival is associated with
age <
55 years, pre-operative WOMAC scores >
45 and, a BMI <
30. In patients over 55 years of age with adequate pre-operative
functional scores, survival can be good and functional outcomes
can be significantly better than their younger counterparts. We
recommend the routine use of pre-operative functional outcome scores
to guide decision-making when considering suitability for high tibial osteotomy. Cite this article:
Between 1993 and 1994, 891 patients underwent
primary anterior cruciate ligament (ACL) reconstruction. A total
of 48 patients had undergone bilateral ACL reconstruction and
42 were available for review. These patients were matched to a unilateral
ACL reconstruction control group for gender, age, sport of primary
injury, meniscal status and graft type. At 15-year follow-up a telephone
interview with patients in both groups was performed. The incidence
of further ACL injury was identified through structured questions
and the two groups were compared for the variables of graft rupture
or further ACL injury, family history of ACL injury, International
Knee Documentation Committee (IKDC) subjective score and activity
level. There were 28 male and 14 female patients with a mean age of
25 years (13 to 42) at the time of first ACL injury. Subsequent
further ACL injury was identified in ten patients (24%) in the bilateral
ACL reconstruction study group and in nine patients (21%) in the
unilateral ACL reconstruction control group (p = 0.794). The mean
time from bilateral ACL reconstruction to further ACL injury was
54 months (6 to 103). There was no significant difference between
the bilateral ACL reconstruction study group and the matched unilateral
ACL reconstruction control group in incidence of further ACL injury
(p = 0.794), family history of ACL injury (p = 0.595), IKDC activity
level (p = 0.514), or IKDC subjective score (p = 0.824). After bilateral ACL reconstruction the incidence of graft rupture
and subjective outcomes were equivalent to that after unilateral
ACL reconstructions. Cite this article:
