Anterior cruciate ligament reconstruction improves activity-induced pain in comparison with pain at rest in middle-aged patients with significant cartilage degeneration.

Abstract

BACKGROUND: Recent reports revealed that outcomes of anterior cruciate ligament (ACL) reconstruction in middle- or old-age patients are comparable with those of young patients. However, in case of concomitant arthrosis in the affected knee, there has been a paucity of literature regarding the outcomes of ACL reconstruction. We studied the level of improvement in pain originating from significant cartilage degeneration in middle-aged ACL-deficient patients after ACL reconstruction. We divided the pain into pain at rest and activity-induced pain.

HYPOTHESIS: The activity-induced pain would be more improved by ACL reconstruction than the pain at rest.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: We studied 36 patients who had undergone arthroscopic isolated ACL reconstruction for functional instability with significant cartilage degeneration grade III or IV without mensical injury. All patients had activity-induced pain; 20 of these patients also had pain at rest. To assess the pain level, the visual analog scale (VAS) was employed, in addition to radiologic and clinical evaluations such as the Lachman test, KT-2000 arthrometer, and pivot shift test. The mean age of the patients was 48.6 years (range, 41-61 years); mean follow-up was 46.7 months (range, 27-74 months).

RESULTS: The preoperative mean VAS of the activity-induced pain (4.1 +/- 1.0; range, 2-6) showed significant improvement at the most recent follow-up (2.0 +/- 1.0; range, 0-4; P < .0001). However, the preoperative mean VAS of the pain at rest (2.9 +/- 0.9; range, 2-5) did not improve significantly at the most recent follow-up (2.5 +/- 0.8; range, 1-4; P = .149). The Lachman test, KT-2000 arthrometer, andpivot shift test showed significant improvement compared with preoperative outcomes (P < .0001). There was no significant difference in radiologic assessment between preoperative and postoperative outcomes (P = .082).

CONCLUSION: Anterior cruciate ligament reconstruction in middle-aged patients with significant cartilage degeneration is effective in reducing activity-induced pain and instability. Even though all patients had less than severe arthritic changes on preoperative radiographs, the pain at rest did not improve after ACL reconstruction.