Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction - Report - MDSpire
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Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction
Increased Osteoarthritis Incidence After ACL Graft Rupture vs Intact Grafts at 3 Decades
Overview
This long-term follow-up study of patients undergoing ACL reconstruction with patellar tendon grafts found a higher incidence of osteoarthritis (OA) in those with graft rupture compared to those with intact grafts 28–33 years post-surgery. Knee laxity and graft failure were associated with increased OA development, supporting the hypothesis that intact ACL grafts reduce OA risk.
Background
ACL injuries are common and often lead to knee instability, pain, and disability. Reconstruction aims to restore knee stability but does not fully prevent osteoarthritis, which has a multifactorial etiology including meniscal and cartilage damage. Long-term outcomes depend on graft integrity and associated injuries. This study evaluates clinical and radiological outcomes decades after ACL reconstruction using patellar tendon grafts.
Data Highlights
Parameter
Value
Initial cohort size
134 patients
Follow-up period
28–33 years (median 31)
Patients evaluated at follow-up
60 patients
Median age at surgery
26 years (range 17–47)
Median age at follow-up
57 years (range 45–79)
Gender distribution
92% men, 8% women
Knee injured (right/left)
58% right, 42% left
Key Findings
Patients with ACL graft rupture showed a significantly increased incidence of osteoarthritis compared to those with intact grafts after 28–33 years.
ACL graft integrity was associated with reduced knee laxity and better long-term joint stability.
Meniscal and cartilage injuries at the time of ACL rupture contributed to OA development but graft failure remained a key risk factor.
The standardized patellar tendon bone-to-bone graft technique was used consistently across patients, minimizing surgical variability.
Long-term radiological and MRI assessments confirmed structural joint changes correlating with clinical instability and OA.
Clinical Implications
Maintaining ACL graft integrity is crucial to reducing the risk of osteoarthritis decades after reconstruction. Clinicians should monitor graft status and address associated meniscal or cartilage injuries to optimize long-term joint health. Early detection and management of graft failure may improve functional outcomes and delay OA progression.
Conclusion
This study demonstrates that ACL graft rupture significantly increases the risk of osteoarthritis 28–33 years post-reconstruction, highlighting the importance of graft preservation for long-term knee joint health.
