International Orthopaedics (SICOT) (1991) 15:367-371 International Orthopaedics © Springer Verlag 1991 Osteoarthritis of the knee after ACL reconstruction A. Ferretti, F. Conteduca, A. De Carli, M. Fontana, and P. P. Mariani Department of Orthopaedic Surgery, University of Rome, La Sapienza, 1-00185 Rome, Italy Summary. One hundred and fourteen knees with deficiency of the anterior cruciate ligament (ACL) which had undergone reconstruction of the ligament using semitendinosus and gracilis were reviewed at a mean of 61 months after operation. Radiological and clinical evaluation was undertaken. A signifi- cant correlation was found between the number of meniscectomies performed in acute cases and those undertaken on the chronic knee. There was also sig- nificant correlation between meniscectomy and the Fairbank grading of degenerative changes seen on the radiographs. There was no correlation between the clinical results, residual laxity and the develop- ment of osteoarthritis. In A CL deficient knees with irreparable meniscal tears, or in which meniscec- tomy had been undertaken, the development of os- teoarthritis seemed independent of the degree of stability, but in such knees with no meniscal tear or meniscal repair, reconstruction appeared to save the menisci and preserve the joint. R+sum~. Les auteurs ont revu, avec un recul de 61 mois, 114 genoux opbrbs pour reconstruction du li- gament croisd antdrieur (LCA) au moyen du demi- tendineux et du droit interne. Une bvaluation clini- que et radiologique a btd effectube. L'analyse des radiographies en charge a montrb une corrblation significative entre l'existence de signes de dbgrada- tion articulaire et les mbniscectomies effectu~es dans le m6me temps que la reconstruction ligamen- taire. Une bonne corrblation a btb bgalement re- trouvbe entre le niveau sportif post-opdratoire et la prbsence de ces signes. Aucune corrblation n'a dtb trouvde entre l'bvolution de l'arthrose et le rbsultat Reprint requests to: A. Ferretti, Piazzale Aldo Moro 5, 1-00185 Rome, Italy clinique, en ce qui concerne la stabilitb. En conclu- sion, dans les cas comportant une lbsion irrbparable des mbnisques et une mdniscectomie, la reconstruc- tion du LCA ne semble pas capable de prbvenir le dbveloppement de l'arthrose post-traumatique. Introduction Although rupture of the anterior cruciate ligament (ACL) has been called "the beginning of the end of the knee" (1), the role of knee instability in the development of osteoarthritis is uncertain. The ra- diographic appearance of the knees of patients with chronic insufficiency of the ACL usually shows only minor arthritic changes [16]. Previous ligament damage has rarely occurred in patients requiring tibial osteotomy or arthroplasty for se- vere osteoarthritis of the knee [7]. The development of early radiographic changes of osteoarthritis, similar to those de- scribed by Fairbank after meniscectomy, has been reported in athletes with untreated ACL insuf- ficency [11]. Other important factors which may influence degeneration in unstable knees include the extent of anatomical injury, the level of activi- ty, pre-existing axial deformity, and associated meniscal tears or chondral damage [8]. There have been few reports describing articu- lar changes in knees after ligament reconstruc- tion, and it is still uncertain if these procedures really reduce the incidence of post-traumatic osteoarthritis of the knee. This paper discusses the radiographic changes observed in 114 knees after ACL reconstruction using the pes anserinus tendons.