Background:

Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes.

Purpose:

To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described.

Results:

Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear.

Conclusion:

Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

中文翻译：

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前交叉韧带重建后二十年的结果：前瞻性收集数据的系统回顾

背景：

近年来发表了几项前交叉韧带（ACL）重建后的长期（≥20年）随访研究，可以对结果进行系统评估。

目的：

总结 ACL 重建后≥ 20 年的结果，并确定影响这些结果的患者和手术因素。

学习规划：

系统审查；证据水平，4。

方法：

确定了通过关节镜或微型开放技术使用腘绳肌或骨-髌腱-骨 (BTB) 自体移植物进行初级 ACL 重建的前瞻性研究，平均随访时间≥20 年。如果可能，计算每个结果测量的平均分数。描述了在个别研究中确定为预测结果的因素。

结果：

五项研究符合纳入和排除标准，共有 2012 名患者。患者报告结果测量的汇总平均随访率为 44.2%（范围，29.6%-92.7%），亲自评估为 33.2%（范围，29.6%-48.9%）。四项研究（n = 584）报告移植物撕裂的平均率为 11.8%（范围，2%-18.5%），4 项研究（n = 773）报告对侧 ACL 损伤率为 12.2%（范围，5.8%-30 %）。对同侧膝关节重复非 ACL 关节镜手术（4 项研究；n = 177）的发生率为 10.4%（范围，9.5%-18.3%），膝关节置换术（1 项研究；n = 217）发生率为 5%。国际膝关节文献委员会主观膝关节功能 (IKDC) 评分的汇总平均值为 79.1（SD，21.8 [3 项研究；n = 644]）。在 2 项研究 (n?= 221) 中，57.5% 的患者继续参加剧烈活动。82.3%（n = 496；3 项研究）的 IKDC 客观评分正常或接近正常，具有临床意义的残余松弛率较低。25.9% 的患者（n = 605；3 项研究）存在中重度放射学骨关节炎 (OA)（IKDC C 或 D 级）。内侧半月板切除术与放射学 OA 的风险增加有关。影像学 OA 严重程度与患者报告的膝关节功能较差有关，但与膝关节疼痛的关联尚不清楚。

结论：

目前可用的使用腘绳肌或 BTB 自体移植物重建 ACL 的前瞻性证据为 20 年的结果提供了一些见解。20 年的随访率从 30% 到 93% 不等。82% 的 IKDC 客观评分正常或接近正常，平均 IKDC 主观评分为 79 分。