Eighteen- to twenty-five-year follow-up after acute partial anterior cruciate ligament rupture

Of 22 consecutive patients with minor knee instability after a partial rupture of the anterior cruciate ligament, all could be reexamined after a mean of 12 years and all but 1 could be reexamined after a mean of 20 years. Three patients needed surgery during the follow-up period, but nobody had an anterior cruciate ligament reconstruction. The Lysholm knee function score was excellent and did not change between 12 and 20 years. Patients had decreased their activities from contact sports before injury to physical fitness activities at the late follow-up. Four patients changed activities because of a knee problem. The quality of life score was somewhat higher than may be expected in an age-matched average population. At late follow-up, eight patients had a 1+ Lachman sign, two a 2+ Lachman sign, and one a positive pivot shift. Also at late follow-up, 7 knees showed no signs of radiographic osteoarthrosis, 10 had Fairbank’s signs, and 3 had minor and 1 a major joint space reduction. Of the 12 patients with longitudinal radiographic observation, 3 knees had developed a higher degree of osteoarthrosis, and 9 had remained unchanged. The patients had a mean age of 48 years at the late follow-up. This suggests that the results may be regarded as final outcome after this specific knee injury.

K. Messner, W. Maletius

Am J Sports Med. 1999 Jul-Aug;27(4):455-9.

PMID: 10424214 

DOI: 10.1177/03635465990270040801

Eighteen- to twenty-four-year follow-up after complete rupture of the anterior cruciate ligament

A unilateral, complete rupture of the anterior cruciate ligament was diagnosed in 60 consecutive patients by arthroscopy within 1 week of trauma. Most ruptured ligaments were treated by acute nonaugmented repair immediately after the arthroscopy. Fifty-five and 56 patients were reevaluated after 12 years and 20 years, respectively. Twenty-five patients (45%) had at least one reoperation during the follow-up period of 20 years, primarily for meniscal problems. Seven patients (13%) had repeat anterior cruciate ligament surgery. The overall Lysholm knee function score remained at a median of 90 points from 12 to 20 years, but patients had decreased their sporting activities from team sports at full rehabilitation to physical fitness activities at the late follow-up. Patients who had repeat surgery had a worse knee function score, were less satisfied with their knees, and also had to change activities and change work more often than patients without reoperation. The majority of patients had, at both follow-up periods, unstable knees. At 20 years, weightbearing radiographs showed slight-to-moderate changes equivalent to osteoarthrosis in 84% (47) of patients and a 32% increase in osteoarthrosis since the 12-year evaluation.

W. Maletius, K. Messner

Am J Sports Med. Nov-Dec 1999;27(6):711-7.

PMID: 10569355

DOI: 10.1177/03635465990270060501

The effect of partial meniscectomy on the long-term prognosis of knees with localized, severe chondral damage. A twelve- to fifteen-year followup

We retrospectively matched 42 patients with unilateral chondral damage in the weightbearing zone of one knee compartment according to sex, age, location of chondral damage, and follow-up time. Two groups of 21 patients were formed. One group had chondral damage only. The other group had chondral damage and a meniscal tear treated with partial meniscectomy. After 12 to 15 years, all patients were reexamined. Twenty-nine percent (N = 6) of the patients who had a partial meniscectomy needed repeat meniscal surgery during followup. No patients with isolated chondral damage developed meniscal symptoms, and only three patients underwent minor surgeries (P < 0.02). At the follow-up evaluation, both groups had similar knee function with a mean Lysholm score of 87 points. However, most patients had reduced their sports activities from competitive individual sports before injury to noncompetitive physical fitness exercise at followup. At the roentgenologic examination, patients who had partial meniscectomies had more severe roentgenologic signs of osteoarthritis than patients who had chondral damage only (P < 0.03). Meniscectomy, varus knee alignment at the follow-up evaluation (P < 0.04), and age older than 30 years (P < 0.04) at the time of the operation were associated with a higher incidence of osteoarthritis.

W. Maletius, K. Messner

Am J Sports Med. 1996 May-Jun;24(3):258-62.

PMID: 8734872

DOI: 10.1177/036354659602400302

Chondral damage and age depress the long-term prognosis after partial meniscectomy. A 12- to 15-year follow-up study

The effect of chondral damage and age on the long-term prognosis after partial meniscectomy was investigated in two matched groups of patients (n = 40), one with intact and the other with severely disrupted cartilage at the time of operation. Twelve to 15 years after meniscectomy a clinical and radiographic examination was done. Significantly more patients with intact cartilage (85%) than with chondral damage at operation (50%) had excellent or good knee function (P < 0.05). The activity levels decreased from active individual sports to physical fitness activities (P < 0.001), equally in both groups. Joint space reduction on roentgenograms was seen in 16 patients (80%) with chondral damage and in 6 patients (30%) with intact cartilage (P < 0.001). In addition to chondral damage, age over 30 years (P < 0.04) at the time of operation was associated with a worse functional (P < 0.03) and radiographic (P < 0.01) outcome.

W. Maletius, K. Messner

Knee Surg Sports Traumatol Arthrosc. 1996;3(4):211-4.

PMID: 8739715

DOI: 10.1007/BF01466619

The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes

We examined 28 young athletes with isolated severe chondral damage in the weight-bearing area of the knee joint clinically and radiographically 14 years after arthroscopic diagnosis. Except for Pridie drilling in 3 cases and occasional cartilage shaving or removal of free bodies, no special treatment was given initially. 21 patients were able to return to preinjury team sport activity levels. During the follow-up period, only 3 patients needed repeat surgery with removal of free bodies, and another 2 underwent diagnostic arthroscopy because of persistent pain. At the latest follow-up evaluation, 22 patients had excellent or good knee function. At this time, the patients were mainly involved in individual sports on a physical fitness level. 12 cases had radiographic joint space reduction (< 50%) which was limited to the compartment concerned.

K. Messner, W. Maletius

Acta Orthop Scand. 1996 Apr;67(2):165-8.

PMID: 8623573

DOI: 10.3109/17453679608994664

Refixation of large chondral fragments on the weight-bearing area of the knee joint: a report of two cases

In most cases of cartilage avulsion, the chondral fragments are severely damaged, and refixation is therefore impossible. We present two cases with large intact cartilage fragments from the weight-bearing area of the femoral condyle after patellar dislocation. We tried refixation using fibrin sealant (Tisseel-Kit, Immuno AG, Vienna, Austria) and polydioxanone-pins (Bio-fix-Pins, Miracon AB, Helsingborg, Sweden). At second look arthroscopy, we found only one third to one half of the defects healed. Due to these results, the refixation of chondral fragments without attached bone seems to be questionable.

W. Maletius, M. Lundberg

Arthroscopy. 1994 Dec;10(6):630-3.

PMID: 7880354

DOI: 10.1016/s0749-8063(05)80060-x

Acute patellar dislocation during eccentric muscle testing on the Biodex dynamometer

Isokinetic training and muscle torque measurements are commonly used during rehabilitation after knee ligament injuries. Isokinetic maximal muscle strength tests are performed to monitor the progress in muscle rehabilitation. The muscle power is evaluated by measuring the applied force in the direction of motion (concentric muscle power) or the force against the direction of motion (eccentric muscle power). Both legs are examined to compare the total muscle work and peak torques of the involved leg with those of the uninvolved leg. We report the case of an acute patellar dislocation during eccentric testing of the uninvolved leg on the Biodex isokinetic dynamometer testing device (Biodex Corporation, Shirley, NY).

W. Maletius, J. Gillquist K. Messner

Arthroscopy. 1994 Aug;10(4):473-4.

PMID: 7945645

DOI: 10.1016/s0749-8063(05)80203-8

An unusual case of vascular abnormality mimicking a lateral meniscal cyst

An unusual case of a vascular abnormality mimicking a lateral meniscal cyst is reported. The patient was a 31-year-old active sportsman who presented with intermittent pain over the lateral aspect of the left knee joint line, occurring only during activities involving twisting motions such as playing soccer. He did not experience local tenderness or swelling, clicking, locking, or giving way. The magnetic resonance imaging, which was done after a diagnostic arthroscopy with normal intra-articular findings, showed a cyst formation of approximately 4-mm diameter adjacent to the lateral meniscus periphery, but no meniscal tissue degeneration. Exactly at the preoperatively marked site of most intensive pain sensation during twisting motions, surgical exposure showed a venous-aneurysm-like tumor, which was removed. The operation resulted in complete relief of symptoms and undisturbed sporting activities including soccer.

A. Vergis, W. Maletius, K. Messner

Arthroscopy. 1995 Oct;11(5):616-9.

PMID: 8534307

DOI: 10.1016/0749-8063(95)90142-6

Long-term results of anterior cruciate ligament reconstruction with a Dacron prosthesis. The frequency of osteoarthritis after seven to eleven years

In this prospective study we investigated 70 patients with chronic anterior instability who underwent anterior cruciate ligament reconstruction with a Dacron prosthesis. Fifty-five (79%) patients could be followed up at a mean of 9 years. Within the follow-up time, 44% (29 of 66) of the prostheses were diagnosed as ruptured; the annual rupture frequency was 5%. Second reconstructions were performed for 20 patients (29%), 5 patients had third reconstructions, and 9 patients wanted no further surgical treatment. Fifty-two patients (74% of the original group) underwent radiographic examination. Eighty-three percent (43) of these patients had radiographic changes in the operated knee, and 40% (21 of 52) had joint space reduction up to 50%. The rate of radiographically detected osteoarthritis was increased 10 times compared with the normal knee. Patients with medical instability and patients older than 30 years at the initial operation had more severe osteoarthritic changes. Based on the functional results of the patients with a ligament in place after 9 years, only 14% (10) of the original group had acceptable stability and knee function.

W. Maletius, J. Gillquist

Am J Sports Med. 1997 May-Jun;25(3):288-93.

PMID: 9167805

DOI: 10.1177/036354659702500303

Long term prognosis of intraarticular knee injuries

Intraarticular knee injuries, still are a challenge for proper treatment in Sports Medicine today .The increasing life expectancy as well as the patient expectation to maintain a sufficiant physica…

W. Maletius

Medicine. 1999

Corpus ID: 68507668

Morphologie und Molekularpathologie der Osteoarthrose

Die biomechanischen Eigenschaften des hyalinen Gelenkknorpels sind in der spezifischen biochemischen Beschaffenheit der extrazellulären Knorpelmatrix begründet, die v.a. aus einem Netzwerk von Kollagenfibrillen sowie der eingelagerten proteoglykanreichen Knorpelgrundsubstanz besteht. Im Rahmen der Osteoarthrose kommt es zu einer chronisch fortschreitenden Zerstörung des Gelenkknorpels und damit zum Funktionsverlust des Gelenksystems. Neben der Degradation von molekularen Komponenten kommt es auch zur Destabilisierung und Zerstörung von supramolekularen Strukturen. Dies sowie die zellulären Reaktionen erklären das morphologische Erscheinungsbild: Die Matrixzerstörung auf molekularer Ebene zeigt sich am Verlust der Anfärbbarkeit für Proteoglykane, die supramolekulare Matrixzerstörung an Rißbildungen und schließlich am Fehlen ganzer Knorpelschichten. Die Zellen reagieren auf diese Veränderung zunächst mit verstärkter Neusynthese von Knorpelmatrixkomponenten. Zusätzlich kommt es zu einer Proliferation v.a. der Knorpelzellen sowie zu Umdifferenzierungen der selben. Für die Behandlung der Osteoarthrose ist eine adäquate Frühdiagnostik mit prognostischer Signifikanz von zentraler Bedeutung. Jedoch sind die bisher für die pathohistologische Diagnostik angewandten konventionellen histologischen und histochemischen Färbetechniken unzureichend und neuartige diagnostische Analysemethoden notwendig.

W. Maletius

Arthroskopie 12 (1999): 3-8.

Corpus ID: 68507668

DOI: 10.1007/s001420050063