Eighty-four percent of males who had ACL knee (anterior cruciate ligament) reconstruction with a patellar tendon (the tendon that attaches the knee to the front of the tibia or shin bone) graft continue at a high level of activity 15 years later, according to a study presented today at the American Orthopaedic Society for Sports Medicine’s Specialty Day in New Orleans, Louisiana (March 13). Additionally, these patients have not developed severe osteoarthritis and their knees remain stable.
“We have done this procedure for many years and this study looks at patients as far back as 17 years,” said Leo Pinczewski, MD, corresponding author and consultant surgeon at the North Sydney Orthopaedic & Sports Medicine Centre, Wollstonecraft, Australia. “The results of this technique, which was new almost 20 years ago, were excellent at five years, outstanding at 10 years and still very, very good at 15 years. Patients went back to sport quickly, had an easy rehabilitation with no brace and were frequently walking straight away.”
The goal of ACL knee surgery is to stabilize the knee with a short rehabilitation letting patients get back to an active lifestyle. Long-term, the surgery aims to prevent additional damage to the knee and minimize osteoarthritis.
But Dr. Pinczewski’s success with the procedure almost didn’t occur, he noted. In 1989, Dr. Pinczewski had gone to a medical seminar to hear Tom Rosenberg, MD, of Salt Lake City, Utah, who had pioneered a surgery to arthroscopically reconstruct the ACL using the patellar tendon. Previously, this knee surgery had been an “open” (not minimally invasive) procedure with a long rehabilitation and a high incidence of osteoarthritis. All he was able to obtain was the procedure summary from literature left at the lecture.
“So, I worked out how to do it from the abstract,” said Dr. Pinczewski. “Little did I know that I got it wrong, according to Dr. Rosenberg’s method. But, in fact, it proved to be fortuitous. The way I performed the surgery was to drill the hole into the femoral bone before drilling into the tibia. Dr. Rosenberg’s technique drilled into the tibia first. It turned out you can get the graft into a better position and a more stable knee if you drill in that order. I didn’t know I had it ‘wrong’ until after I’d performed hundreds of successful operations.”
In the study, 90 patients (46 men and 44 women between 15-42 years) had endoscopic ACL knee surgery performed by Dr. Pinczewski. After 15 years, 82 patients (88%) were examined and documented. In evaluating knee function (limp, locking, instability, pain, swelling and trouble climbing stairs), the patients had a median score of 95 (in a range of 39-100). Rating the function of their knee on a scale of 0 – 10, with 10 being normal, excellent function and 0 being inability to perform daily activities, patients reported their knee function at an average of 9.5 after 15 years.
As for sports participation, 84 percent of males and 45 percent of females were participating in very strenuous activities such as soccer and basketball or in strenuous activities such as skiing or tennis. 24 percent of patients participated in moderate activities such as running or jogging and14 percent participated in light activities such as walking 15 years after surgery. However, 89 percent of patients had no signs of osteoarthritis at 15 years after the surgery. The study did note a concern for increased kneeling pain in patients due to the donor site for the patellar tendon graft that needed further scrutiny.