Long term prognosis of intraarticular knee injuries

Sammanfattning: 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 physical activity up to high ages gives the topic an increasing publicity. Still, the long tenn prognosis of the most conunon intraarticular knee injuries including cartilage injuries remaines unclear. The general purpose of this work was to investigate the long- term prognosis after common intraarticular knee injuries in respect to lrnee function, sports performance, knee stability and development of radiographical osteoarthrosis.In this series, 221 patients were examined. The initial diagnosis in all cases was placed by manual examination under anesthesy and arthroscopy. The patients were reexamined at different long-term follow-up intervalls by an interview, including a subjective lmee score and an activity score, a thorough manual examination, and a radiographical examination including weight-bearing radiographs. In a part of the patients, a quality of life score was used.Patients with isolated chondral damage in one knee had a good long-term functional' prognosis but developed mild to moderate signs of radiographical osteoarthrosis in the majority of the cases.Complete ACL tears resulted in a permanent increase of sagittal knee translation no matter which initial treatment Injuries to knee joint cartilage or menisci or partial injuries to the ACL did not result in an increase of sagittal translation.Radiographical signs for osteoarthrosis were encountered in 55 to 87% after different knee injuries, and seemed to advance slowly during the years.Combined intraarticular knee injuries seemed to have a higher risk for development of radiographical osteoarthrosis than isolated injuries within the same time period.Older age at initial diagnosis and treatment of an intraarticular knee injury is associated with a higher risk to develop radiographlcal osteoarthrosis.After 12 to 20 years, patients with minor intraarticular knee injuries seem to have only a marginally better longterm prognosis for knee function and activity participation than patients with combined, major intraarticular knee injuries. However, the higher dissatisfaction with the results, the higher rate of symptoms and subsequent repeat surgery as well as the higher development of oeteoarthrosis during the years in the latter cases may point to that the risk for future lmee deterioration is greater after a combined than after a minor or/and isolated knee injury.Subjective satisfaction and quality of life was high after a partial rupture of the ACL with minor concomitant injuries, and stayed unchanged over the years. In contrast, a complete rupture of the ACL did adversely influence quality of life, and subjective satisfaction with knee performance declined with time.