Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years

 Struewer J, Ziring E, Frangen TM, Efe T, Meissner S, Buecking B, Bliemel C, Ishaque B. Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years. Int Orthop. 2013 Feb;37(2):271-7.

 Reconstruction of isolated ACL tear is still debatable and one of the projected benefit is that reconstruction will prevent undue stresses on the cartilage and delay osteoarthritis. In this recent paper  the osteoarthritis rate at 2 to 10 years follow up were alarming after ACL reconstruction in isolated ACL tear.  The mean long-term follow-up was 10.2 years (eight–13 years), and the mean age was 40.4 years (24–62 years). 

Radiological assessment revealed degenerative changes in the sense of a grade I OA in 21.2 % of patients. Prevalence of a grade II OA was found in 53.8 % of patients. A grade III OA and a grade IV OA were found in 19.2% and 5.7 %.

Preoperative 9.8% had grade I OA and at follow up 99.9% have radiological OA.

This raises a some Questions

Can ACL reconstruction prevent onset and progression of OA?
Will the result be any different in with conservative management in terms of OA?
Should prevention of OA be one of the rationale to do ACL reconstruction?
Yes there are advantages of ACL reconstruction in symptomatic patients and in atheletes but in an Asymptomatic patient on a good rehab is ACL reconstruction needed for isolated ACL tear?

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