As orthopedic surgeons, we focus on helping athletes return to sports after ACL reconstruction. After all, most of our patients are athletes and want to return as soon as they can.
How do patients do long term after the surgery? A large percentage of patients are teenagers or in their early 20s when they have surgery. How is their knee when they are in their 40s? Are they active? Do they develop arthritis?
A study recently published in the American Journal of Sports Medicine shines some light on these questions. Simon Thompson and other Australian researchers studied 333 consecutive patients who underwent ACL reconstruction with patellar tendon autografts between January 1993 and April 1994. 90 patients met the inclusion criteria and were available for follow-up 20 years after surgery. The findings on patient outcomes 20 years after surgery are interesting.
A large percentage of patients suffer another injury. 36% of the patients had suffered a rupture of either the opposite knee’s ACL or tore the graft in the surgical knee.
Patients are often still very active. 20 years after surgery, 35% of patients still engaged in very strenuous activities like soccer. 15% engaged in strenuous activities like tennis or skiing. 38% performed moderate intensity activities like jogging.
Most patients had few symptoms. 78% could perform physical activities without pain. 76% could do so without swelling of the knee. 88% could perform activities without their knee giving way.
Arthritis often developed over time. 27% of patients had evidence of osteoarthritis five years after surgery. 51% showed changes at 15 years, and 61% had osteoarthritis findings at 20 years. Only 20% of patients, though, exhibited moderate osteoarthritis, and none had severe OA changes.
This long-term data suggests that patients do well in many respects years after ACL surgery. Most patients can expect to play sports and exercise at a high level. They rarely have pain or other limiting symptoms.
On the other hand, osteoarthritis develops in a high percentage of patients, making it difficult to claim that ACL reconstruction can prevent arthritis from developing after injury. Also, secondary ACL injuries, either to the reconstructed knee or the contralateral knee, occur more than we might have previously realized.
These findings might help us better counsel patients before ACL surgery and give them a better idea of what to expect.
Do these findings surprise you? Have you had an ACL surgery many years ago? How are you doing now? Share your thoughts or experiences below!
Thompson S, Salmon L, Waller A, Linklater J, Roe J, Pinczewski L. Twenty-Year Outcomes of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts. Am J Sports Med. Published online ahead of print July 17, 2015.