Isolated Tears of the Anterior Cruciate Ligament Over 30-Year Follow-up of Patients Treated with Arthrotomy and Primary Repair

• Published in: The American journal of sports medicine Vol. 37; no. 1; pp. 65 - 71
• Main Authors: Taylor, Dean C., Posner, Matthew, Curl, Walton W., Feagin, John A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2009; Sage Publications; Sage Publications Ltd
• Subjects: Aged; Anterior Cruciate Ligament - surgery; Arthroscopy; Arthroscopy - methods; Biological and medical sciences; Clinical outcomes; Diseases of the osteoarticular system; Follow-Up Studies; Humans; Injuries of the limb. Injuries of the spine; Knee; Knee Injuries; Ligaments; Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care) - methods; Postoperative Period; Surveys and Questionnaires; Traumas. Diseases due to physical agents; knee; ACL reconstruction; primary repair; Knee; Human; Arthrotomy; Treatment; Ergonomics; Surgery; Break; Anatomical reconstruction; Repair; Anterior cruciate ligament
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546508325660

Background
Over 30 years ago, Feagin and Curl reported on the diagnosis and treatment of “isolated” injuries of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the long-term results of the patients initially diagnosed with tears of the ACL, with special emphasis on those treated with primary repair.
Hypothesis
Long-term results are unsatisfactory for open evaluation and treatment of ACL injuries with or without primary repair.
Study Design
Case series; Level of evidence, 4.
Methods
Follow-up was available on 34 of the original 57 patients (60%) who had ACL tears on evaluation by arthrotomy. The average age at the index procedure was 20 years, and average follow-up was 32 (range, 29-36) years. Twenty-five of the 26 complete ACL tears were treated with primary repair. None of the 8 partial tears was repaired. Evaluations included the subjective and symptom ratings of the International Knee Documentation Committee (IKDC) evaluation form, Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, and SANE rating.
Results
For the IKDC subjective score, 18 of 34 patients rated their knees as normal or nearly normal. The Lysholm scores averaged 70.1 (range, 20-100). The average SANE rating at 5 years was 74.8 (range, 49-110), and the current SANE rating averaged 68.9 (range, 10-100). The overall KOOS rating averaged 68.6 (range, 26.4-100). The Tegner activity score was 3.7. There was little difference between patients with unrepaired partial tears and those who had primary repairs.
Conclusion
At more than 30-year follow-up, patients have decreased activity levels and an equal mix of acceptable and unacceptable outcomes. We were unable to identify any predictive factors that correlated with the results; however, subsequent meniscal surgery did correlate with poor results. The results at greater than 30 years reinforce the 5-year results that showed unsatisfactory results after the open evaluation and treatment of ACL injuries with or without repair.