20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: The Catastrophic Effect of Age and Posterior Tibial Slope

Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect...

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Bibliographic Details
Published in:The American journal of sports medicine 2018-03, Vol.46 (3), p.531-543
Main Authors: Salmon, Lucy J., Heath, Emma, Akrawi, Hawar, Roe, Justin P., Linklater, James, Pinczewski, Leo A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adults
Age Factors
Anterior Cruciate Ligament Injuries - surgery
Anterior Cruciate Ligament Reconstruction - methods
Autografts - surgery
Case-Control Studies
Endoscopy
Female
Graft Survival
Hamstring Tendons - transplantation
Humans
Knee
Knee Joint - surgery
Ligaments
Male
Medical procedures
Middle Aged
Patient Reported Outcome Measures
Prospective Studies
Radiography
Skin & tissue grafts
Sports medicine
Teenagers
Tendons
Tibia - surgery
Transplantation, Autologous
Treatment Outcome
Young Adult
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Summary:Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored. Purpose: To compare the prospective longitudinal outcome of “isolated” ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT-1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161). Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score (P = .29), return to preinjury activity level (P = .84), current activity level (P = .69), or degree of radiological degenerative change at 20 years (P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group (P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of ≥12° was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of ≥12° (P = .001) compared with adults with a PTS
ISSN:0363-5465
1552-3365
DOI:10.1177/0363546517741497