Comparison of postoperative knee osteoarthritis after isolated anatomical single bundle and transtibial anterior cruciate ligament reconstruction: A 10–16-year comparative study Vergleich der postoperativen Kniearthrose nach isolierter anatomischer Single-bundle- und transtibialer Rekonstruktion des vorderen Kreuzbands: Eine 10- bis 16-jährige Vergleichsstudie

Balakkiz B., Haberal B., Acar M., Ilhan H. Y., ÖZER H., Kayaalp A., ...Daha Fazla

Orthopadie, 2026 (SCI-Expanded, Scopus) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1007/s00132-026-04802-3
  • Dergi Adı: Orthopadie
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Anahtar Kelimeler: Anatomical reconstruction, Functional outcomes, Long-term outcomes, Radiographic progression, Tunnel orientation
  • Gazi Üniversitesi Adresli: Evet

Özet

Background: Anterior cruciate ligament (ACL) reconstruction improves knee stability but does not fully prevent the development of postoperative osteoarthritis (OA). Most long-term OA outcomes reported in the literature are derived from traditional transtibial reconstruction techniques, which may not adequately reflect the results of contemporary anatomical reconstruction. Therefore, the aim of this study was to compare the long-term development of knee OA following isolated anatomical single bundle and transtibial ACL reconstruction while accounting for potential confounding factors. Methods: This study included 48 patients who underwent isolated ACL reconstruction without concomitant meniscal, cartilaginous or additional ligamentous injuries. Participants were classified into anatomical (n = 35) or transtibial (n = 13) reconstruction groups. Radiographic OA was assessed using the Kellgren-Lawrence grading system. Knee muscle torque was evaluated with an isokinetic dynamometer, functional outcomes with the Knee Society Score (KSS), and activity level with the Tegner Activity Score (TAS). Comparisons were performed before and after stratification for age and postoperative duration. Results: Radiographic OA was identified in 29% of the participants. In unadjusted analyses, and was less frequent in the anatomical reconstruction group than in the transtibial group; however, after stratification for age and duration of postoperative follow-up, no significant difference in OA prevalence was observed between the two reconstruction techniques (p > 0.05). Muscle strength, functional outcomes and activity levels were comparable between groups. Conclusion: Although anatomical ACL reconstruction was associated with a lower unadjusted prevalence of OA, this apparent advantage was not maintained after accounting for age and postoperative duration. These findings suggest that improved graft positioning alone may not be sufficient to reduce the long-term risk of OA following ACL reconstruction. Graphic abstract: (Figure presented.)