Isolated total ruptures of the anterior cruciate ligament - a clinical study with long-term follow-up of 7 years

Seventy patients met our inclusion criteria in this retrospective study, al l with an arthroscopic/arthrotomic-verified isolated total anterior cruciat e ligament (ACL)-rupture and a minimum follow-up period of 3 years and no a ssociated lesions. Due to emigration/death, 3 patients were not available f or follow-up. Of the remaining 67, 25 patients underwent secondary ACL-reco nstruction, equivalent to a failure rate of the initial non-operative treat ment of 37%. All patients were initially treated conservatively. This left 42 patients for follow-up - 9 answered a questionnare and 33 went through f ollow-up examination after a median of 7.1 years (range 3.3-14.6) including IKDC-evaluation form, Lysholm & Tegner score, ESSKA-score, clinical examin ation and Stryker Laxity test. In the present study all values represent th e 33 patients available for follow-up. Soccer, handball and alpine skiing w ere most frequently responsible for the injury. We observed in the 33 patie nts a decline in median Lysholm score from 100 (90-100) pretraumatic to 86 (42-100) at follow-up, and a decrease in median Tegner values from 7 (3-9) pretraumatic to 5 (2-7) at follow-up. All but 2 patients demonstrated a dec line in Lysholm score, and only 3 patients returned to their preinjury leve l. According to the ESSKA-classification, the number of "cutting-sports per formers" declined dramatically from 24 to 2. All but one patient ascribed t heir decline in activity to their knee status. The Stryker-measured AP-tran slocations were significantly higher on the injured knee (7.27) compared to the healthy knee (4.80) (P<0.05). Intermittant rest pain was suffered by 6 3% of the patients. During the time from inclusion until follow-up, 13 (39% ) patients sustained an additional ipsilateral knee lesion, most commonly a tear of the medial meniscus. The overall outcome was expressed in a low fr equency of return to unrestricted preinjury level of function, and a high l evel of instability complaints resulting in many secondary ACL-reconstructi ons. Naturally some have adapted to their ultimate functional disability, b ut only through modification of activities, and the overall outcome after c onservative therapy of these ACL-ruptures was not satisfactory.