ACL reconstruction with the BPTB graft with and without a ligament augmentation device: A 25-year follow-up of a prospective randomized controlled trial
ESSKA Academy. Elveos M. May 12, 2018; 218111; FP43-1943
Marlene Elveos
Marlene Elveos
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Objectives: To compare the 25-year follow-up results after ACL reconstruction with bone-patellar tendon-bone (BPTB) graft with or without the Kennedy LAD.

Methods: In this prospective randomized controlled trial, a total of 100 patients undergoing ACL reconstruction between 1991 and 1993 were randomized into two groups; reconstruction with BPTB graft (BPTB group) or BPTB graft with the Kennedy LAD (LAD group). There were 51 patients in the BPTB group and 49 patients in the LAD group. The current 25-year follow-up evaluation included clinical knee examination, various patient reported outcomes and assessment of radiological osteoarthritis (OA) according to the Ahlbäck classification. Additional outcomes were number of patients with reruptures and knee arthroplasties. The Mann Whitney U-test, the Pearson chi square test and the Fishers exact test were used to conduct our statistical analysis. Differences were considered statistically significant when P < 0.05.

Results: A total of 93 patients (93%) were available for follow-up evaluation; 48 patients in the BPTB group and 45 patients in the LAD group. The majority of the patients had a negative or 1+ Lachman and Pivot shift result. Mean Lysholm functional score was 85 for the BPTB group and 83 for the LAD group. All of the mean Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores were above 70, with the best results for Pain, Symptoms and Activities of Daily Living (ADL). There were no statistically significant differences between the groups regarding any of these outcomes, the Tegner activity scale, radiological assessments of OA or number of ACL reruptures. There was, however, a significant difference in the mean side-to-side difference with the KT-1000 arthrometer between the two groups in favor of the LAD group (P = 0.021). Signs of radiographical OA was detected in all patients and severe radiographical OA, defined as Ahlbäck III, IV or V, was detected in 32% of the patients in the BPTB group and 21% of the patients in the LAD group (P = 0.37). One patient in the BPTB group and six in the LAD group had undergone knee arthroplasty (P = 0.054).

Conclusions: In the present study, patients with BPTB graft with or without LAD show good clinical and subjective outcomes 25 years after ACL reconstruction. All patients in both groups had signs of radiological OA. Less than one-third of the patients in both groups had severe radiological OA. There was a tendency towards more knee arthroplasties in the LAD group compared with the BPTB group.

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