Journal
AMERICAN JOURNAL OF SPORTS MEDICINE
Volume 37, Issue 3, Pages 471-480Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0363546508326709
Keywords
anterior cruciate ligament; range of motion; meniscus; radiographs; long-term results
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Funding
- Methodist Health Foundation
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Background: Few long-term studies exist that evaluate how the loss of normal knee range of motion affects results after anterior cruciate ligament reconstruction. Hypothesis: Patients with normal knee motion will have higher subjective scores than patients with less than normal motion. Study Design: Cohort study; Level of evidence, 2. Methods: Patients were prospectively evaluated at >10 years after anterior cruciate ligament reconstruction according to International Knee Documentation Committee criteria. Normal knee motion was within 2 of extension (including hyperextension) and 5 of flexion compared with the uninvolved knee. Regression analysis was performed to determine what factors affected subjective scores. Results: Objective follow-up was obtained on 502 patients at a mean of 14.1 years postoperatively. Regression analysis showed that the most statistically significant factor related to lower subjective scores was lack of normal knee extension; loss of normal flexion was also significant. Patients who had meniscectomy or articular cartilage damage had statistically significantly lower subjective scores if they also had less than normal motion. Ninety-eight percent of patients with intact menisci, normal articular cartilage, and normal knee motion had normal radiographs; 29% of patients with normal motion had less than normal radiographs versus 71% of patients who had less than normal motion. The overall International Knee Documentation Committee objective grade was normal in 48%, nearly normal in 42%, abnormal in 9%, and severely abnormal in 0.5%. Conclusion: The loss of 3 to 5 of knee extension, to include loss of hyperextension, adversely affected the subjective and objective results after surgery, especially when coupled with meniscectomy and articular cartilage damage.
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