Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction

Purpose The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. Methods The cohort comprised 60 patients with a median follow-up 31 (range 28–33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. Results Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft ( p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment ( p = 0.013) and the patellofemoral compartment ( p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts ( p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft ( p = 0.0003) and similar results in those with intact graft ( p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft ( p < 0.0001). Conclusions Median 31 (range 28–33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. Level of evidence Retrospective cohort study, Level III.