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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 11, 1483-1487.
doi: 10.1302/0301-620X.87B11.16138  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament

A STUDY USING SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY AT TEN YEARS

A. J. Hart, MA, FRCS(Orth), Specialist Registrar1; J. Buscombe, FRCR, Consultant in Nuclear Medicine2; A. Malone, FRCS(Orth), Specialist Registrar1; and G. S. E. Dowd, MD, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon2

1 Institute of Orthopaedics & Musculo-Skeletal Science Royal National Orthopaedic Hospital Campus, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
2 Royal Free Hospital, Pond Street, Hampstead, London NW3, UK.

Correspondence should be sent to Mr A. J. Hart; e-mail: Alisterjhart{at}yahoo.com

We used single-photon emission computed tomography (SPECT) to determine the long-term risk of degenerative change after reconstruction of the anterior cruciate ligament (ACL). Our study population was a prospective series of 31 patients with a mean age at injury of 27.8 years (18 to 47) and a mean follow-up of ten years (9 to 13) after bone-patellar tendon-bone reconstruction of the ACL. The contralateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score, 93; mean Tegner activity score, 6). Fifteen patients had undergone a partial meniscectomy and ACL reconstruction at or before reconstruction of their ACL.

In the group with an intact meniscus, clinical symptoms of osteoarthritis (OA) were found in only one patient (7%), who was also the only patient with marked isotope uptake on the SPECT scan compatible with OA. In the group which underwent a partial meniscectomy, clinical symptoms of OA were found in two patients (13%), who were among five (31%) with isotope uptake compatible with OA. Only one patient (7%) in this group had evidence of advanced OA on plain radiographs.

The risk of developing OA after ACL reconstruction in this series is very low and lower than published figures for untreated ACL-deficient knees. There is a significant increase (p < 0.05) in degenerative change in patients who had a reconstruction of their ACL and a partial meniscectomy compared with those who had a reconstruction of their ACL alone.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General