Introduction and Aims: This longitudinal prospective study reports the 10-year results of anterior cruciate ligament (ACL) reconstruction in 90 patients with isolated ACL rupture.

Method: Three hundred and thirty-three patients undergoing endoscopic ACL reconstruction over a 15-month period using patellar tendon autograft and interference screw fixation were evaluated prospectively. Those patients with an associated ligament injury, chondral damage, previous meniscectomy, excision > 1/3 of one meniscus, an abnormal radiograph or contra-lateral knee, or a compensable injury were excluded. This left 90 patients in the study group. Evaluation was conducted annually for five years, then at seven and 10 years after surgery and included the IKDC Standard Evaluation, Lysholm knee score, kneeling pain, KT1000 testing and weight-bearing radiographs at two, five, seven and 10 years.

Results: Repeat ACL injury occurred in a total of 23 patients (26%). There were six cases of graft rupture (7%) and 18 cases of contralateral ACL injury (20%). One patient suffered both a contralateral and graft ACL rupture. Eight patients (9%) underwent surgery for meniscal or chondral symptoms during the 10-year period. Of the 84 patients with intact grafts at 10 years, 75 (89%) were reviewed. On radiological examination at 10 years, 47% displayed mild to moderate evidence of osteoarthritis. The median Lysholm knee score was 95. Ninety-six percent felt their knee was normal or nearly normal. Forty-seven percent were still participating in moderate to strenuous activity after 10 years. Eighty-seven percent reported that their knee did not affect their activity level. Ninety-seven percent had grade 0–1 on Lachman and pivot shift testing. On instrumented testing 81% had < 3mm of anterior tibial displacement. Twenty-five percent displayed loss of extension range when compared to the contralateral limb, however this was < 5 degrees in 20% of patients. Pain on kneeling was present in 56%. On overall IKDC assessment, 77% were normal or nearly normal.

Conclusion: Endoscopic ACL reconstruction using the PT autograft and interference screw fixation achieves and maintains excellent subjective results and objective stability. This combined with the low incidence of patients requiring subsequent meniscal or chondral surgery enforces the meniscoprotective function of ACL reconstruction. However, early signs of osteoarthritis are developing at 10 years, as displayed by radiological examination and early loss of extension.