20 Year Outcomes of ACL Reconstruction with Hamstring Tendon Autograft. Does Age Matter?

Abstract

Introduction : The purpose of this study was to document the prospective longitudinal outcome of ' isolated ' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft over 20 years . Long term outcomes were compared between those undergoing ACL reconstruction age 18 or less and those >18 years the time of surgery . Methods : A total of 100 consecutive men and 100 consecutive women with ' isolated ' ACL rupture underwent four - strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon . At the time of ACL reconstruction 39 participants were aged 18 or less , 81 were aged 19 to 25 and 80 were over 25 . Reviews were performed pre - operatively and at 1 , 2 , 7 , 15 and 20 years post - operatively . Outcomes included further ACL injury , clinical examination , subjective and objective scoring systems , and radiological assessment . Results : Further ACL injury occurred in 55 of the 200 patients (28%) , 37 ruptured the ACL graft and 22 ruptured the contralateral ACL . ACL graft rupture was significantly increased in the young ; 39% in those aged 18 or less , 21% of those aged 19 - 25 and 6% of those over 25 years (p=0 . 001) . Participants with a posterior tibial slope of 12 degrees or more sustained a further ACL injury in 65% of cases . Moderate to severe radiological degenerative change was evident in 14% at 20 years . Outcomes were not statistically different between those aged 18 or less and those >18 years for the variables of IKDC subjective score (p=0 . 98) , rate of return to preinjury activity level (p=0 . 32) , current activity level , or degree of radiological degenerative change at 20 years (p=0 . 65) . Conclusions : ACL reconstructive surgery in patients with an ' isolated ' rupture using this technique was associated with good long term outcomes and does not appear to cause osteoarthritis , regardless of age . However further ACL injury after ACL reconstruction is significantly more common in the young and those with a high posterior tibial slope .