A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years.

BACKGROUND: The management of cartilage and osteochondral lesions in the knee remains problematic and controversial. Our group reported the 2-year and 5-year results of a randomized controlled trial comparing autologous chondrocyte implantation (ACI) and microfracture in patients with focal femoral cartilage injuries. The objective of the present study was to report the long-term results. METHODS: Eighty patients with a single symptomatic chronic cartilage defect on the femoral condyle without general osteoarthritis were included in the study at the time of the index operation (January 1999 to February 2000). We used the International Cartilage Repair Society (ICRS), Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data at the time of inclusion and at follow-up evaluations. Standing weight-bearing radiographs were evaluated for evidence of osteoarthritis according to the method described by Kellgren and Lawrence. For the long-term follow-up in 2014, we used the Synaflexer frame to standardize the radiographs. The operation was considered to have failed if a reoperation was performed because of symptoms from a lack of healing of the treated defect. RESULTS: At the long-term follow-up evaluation, no significant differences between the treatment groups were detected with respect to the results on the clinical scoring systems. At the 15-year evaluation, there were 17 failures in the ACI group compared with 13 in the microfracture group. We observed that more total knee replacements were needed in the ACI group than in the microfracture group (6 compared with 3). The surviving patients in both groups, i.e., those who had not had a failure, had significant improvement in the clinical scores compared with baseline. Fifty-seven percent of the surviving patients in the ACI group and 48% of such patients in the microfracture group had radiographic evidence of early osteoarthritis (a Kellgren and Lawrence grade of ≥2); the difference was not significant. CONCLUSIONS: The survivors in both groups improved their clinical scores in the short, medium, and long-term evaluations, and no significant difference between the groups was found at the long-term follow-up. The risk of treatment failure and the frequency of radiographic osteoarthritis are problematic. Our findings raise serious concerns regarding the efficacy of these procedures in delaying osteoarthritis and preventing further surgery. Continued basic and clinical research is needed in this field. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Femoral fixation of hamstring tendon grafts in ACL reconstructions: the 2-year follow-up results of a prospective randomized controlled study.

PURPOSE: Hamstring tendon grafts are commonly used in anterior cruciate ligament (ACL) reconstructions. A number of fixation devices are available; however, several have limited clinical support. To our knowledge, no randomized controlled study comparing the EZLoc and the Bone Mulch Screw for femoral fixation in ACL reconstruction exists. Therefore, the purpose of this study was to compare the results following the use of these two femoral fixation devices. Time in surgery for the two methods was also to be compared. METHODS: A total of 110 patients between 18 and 45 years old at two orthopaedic departments, A (n = 55) and B (n = 55), were randomized to ACL reconstruction with femoral fixation of the hamstring graft with either the EZLoc or the Bone Mulch Screw. Surgical time was measured for each group. The patients were evaluated after 6 weeks and 3, 6, 12 and 24 months. The clinical examination included range of motion, evaluation of intraarticular swelling, tenderness at the lateral femoral condyle, the Lachman test, the Pivot shift test and the KT-1000 arthrometer. In addition, the visual analogue scale score for pain, the Tegner activity score, the Lysholm functional score and the knee injury and osteoarthritis outcome score were recorded. Knee extension and flexion muscle strength were also measured with a Biodex. RESULTS: There were no significant differences in any of the parameters mentioned above at the 2-year follow-up evaluation. Three patients in each group underwent revision ACL reconstruction during the study. More than 95% of the knees in both groups were found to be stable. Good to excellent results were found for all selected knee scores in both groups. There were no statistically significant differences between the two groups in any of the muscle strength parameters. Time in surgery was statistically significantly shorter in the EZLoc group compared with the Bone Mulch group. CONCLUSION: There were no statistically significant differences in clinical findings, knee scores or in muscle strength between the EZLoc group and the Bone Mulch group at the 2-year follow-up evaluation. Time in surgery was statistically significantly shorter for patients undergoing ACL reconstruction with hamstring grafts when the EZLoc femoral fixation device was used. LEVEL OF EVIDENCE: II.

Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstructions.

PURPOSE: Several studies compare the short- and long-term results of anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft or double-looped semitendinosus and gracilis (DLSG) graft. However, no studies evaluate the long-term results of BPTB grafts fixed with metal interference screws and DLSG grafts fixed with the Bone Mulch Screw and the Washer Loc. This prospective randomized multicentre study has the null hypothesis that there is no difference in long-term outcome between the two procedures. METHODS: A total of 114 patients with a symptomatic ACL rupture were randomized to reconstruction with either a BPTB graft (N = 58) or a DLSG graft (N = 56). Follow-up was conducted after one, two and seven years. At the seven-year follow-up, 102 of the 114 patients (89%) were available for evaluation; however, 16 of these by telephone-interview only. RESULTS: Ten patients in the BPTB group and 19 patients in the DLSG group underwent additional knee surgery (P = 0.048), two and three, respectively, of these were ACL revisions (n.s.). The total flexion work was lower in the DLSG group (P = 0.001). The mean peak flexion torque and extension work, however, showed no difference between the groups. No significant differences were found between the groups regarding the Tegner activity score, the Lysholm functional score, the Knee injury and osteoarthritis outcome score (KOOS), subjective knee function, anterior knee pain or mobility. There was no significant difference in laxity between the groups on the Lachman test or the KT-1,000 maximum manual force test. CONCLUSIONS: Both grafts and fixation methods resulted in satisfactory subjective outcome and objective stability. Both these methods can therefore be considered as suitable alternatives for ACL reconstructions. LEVEL OF EVIDENCE: II.

Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions.

PURPOSE: Anterior cruciate ligament (ACL) ruptures are common, especially among young athletes, and such injuries may have considerable impact on both sport careers and everyday life. ACL reconstructions are successful for most patients, but some suffer from persistent giving-way symptoms and/or re-ruptures requiring revision surgery. The aim of this study was to evaluate the results after revision ACL reconstructions and compare them with the results in a control group consisting of primary ACL reconstructions. METHODS: This retrospective study included 56 patients undergoing revision ACL reconstruction and 52 patients receiving primary ACL reconstructions. The follow-up evaluation included clinical examination, instrumented laxity testing, testing of muscle strength, Tegner activity score, Lysholm score, Knee injury and osteoarthritis outcome score (KOOS) and radiological grading of osteoarthritis. RESULTS: The median time from the last ACL reconstruction to follow-up was 90 months in the revision ACL reconstruction group and 96 months in the primary ACL reconstruction group. The revision group had significantly inferior KOOS and Lysholm scores compared with the primary group. Patients in the revision group also showed greater laxity measured with the pivot shift test, a larger reduction in the Tegner activity score, reduced muscle strength in the injured knee, and more severe radiological osteoarthritis; however, no difference in anterior-posterior translation was found. CONCLUSION: Inferior results were found on several of the testing parameters in the revision group compared with the primary group. Patients should receive this information prior to revision ACL reconstructions. LEVEL OF EVIDENCE: III.

Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods.

ACL reconstruction with bone patellar tendon bone (BPTB) grafts has been shown to produce dependable results. Recently, reconstructions with double-looped semitendinosus gracilis (DLSG) grafts have become common. The prevailing opinion is that ACL reconstruction with patellar tendon graft produces a more stable knee with more anterior knee pain than DLSG grafts, while the functional results and knee scores are similar. The present study evaluates BPTB grafts fixed with metallic interference screws and DLSG grafts fixed with Bone Mulch Screw on the femur and WasherLoc fixation on the tibia. All else being the same, there is no difference in the outcome between the two grafts and fixation methods. This is a prospective randomized multicenter study. A total of 115 patients with isolated ACL ruptures were randomized to either reconstruction with BPTB grafts fixed with metal interference screws (58 patients) or DLSG grafts (57 patients) fixed with Bone Mulch Screws and WasherLoc Screws. Follow-up was at one and two years; the latter by an independent observer. At two years, one ACL revision had been performed in each group. Eight patients in the DLSG group and one in the BPTB group underwent meniscus surgery in the follow-up period (P = 0.014). Mean Lysholm score at the two year follow-up was 91 (SD +/- 10.3) in the DLSG group and also 91 (SD +/- 10.2) in the BPTB group. Mean KT-1000 at two years was 1.5 mm in the BPTB group and 1.8 mm in the DLSG group (n.s.). At two years, four patients in the BPTB group and three in the DLSG group had a Lachman test grade 2 or 3 (n.s.). More patients in the BPTB group had pain at the lower pole of the patella (P = 0.04). Peak flexion torque and total flexion work were lower in the DLSG group at one year (P = 0.003 and P = 0.000) and total flexion work also at two years (P = 0.05). BPTB ACL reconstruction fixed with interference screws and DLSG fixed with Bone Mulch Screws on the femur and WasherLoc Screws on the tibia produce satisfactory and nearly identical outcomes. Among our patients in the DLSG group, flexion strength was lower, and more patients underwent meniscus surgery in the follow-up period. The BPTB group has more anterior knee pain.

A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.

BACKGROUND: The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. METHODS: Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. RESULTS: At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. CONCLUSIONS: Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.

Meniscal repair with biofix arrows: results after 4.7 years' follow-up.

BACKGROUND: Absorbable meniscus arrows have, since they were introduced in 1993, become a common all-inside technique in meniscal repair. Potential advantages are conserving the meniscus, simplifying the surgical technique, reducing operating time, and reducing the risk of neurovascular damage. Despite extensive use all over the world, few long-term follow-up studies have been published. HYPOTHESIS: Meniscus arrows have, based on published material, a rate of success around 80% to 90%. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The Biofix arrow fixation technique was used in 123 patients in need of meniscal repair from January 1997 to December 2002 at our hospital. The patients underwent an interview by phone, mail, or e-mail during autumn 2004 that included questions about reoperation and Lysholm score. In addition, the operative charts were reviewed. RESULTS: There were 118 patients (96%) available for the questionnaire, and 45 of these (38%) had had reoperations done because of meniscal rerupture during the follow-up period. Another 3 patients were waiting for meniscal reoperations. In addition, the charts of 2 of those unavailable for the study showed that they had been reoperated, resulting in a total of 41% verified failures. The Lysholm score for the whole study group at follow-up was 85 (range, 36-100). The mean Lysholm score for those who had a second operation was 81 (range, 36-100), and it was 88 (range, 55-100) for the others (P = .009). The mean time between primary operation and reoperation was 17 months (range, 1-75 months). Mean postoperative follow-up was 4.7 years (range, 1.8-7.7 years). CONCLUSION: Meniscal repair with Biofix arrows has an unacceptably low rate of success.

Comparison of in vitro and in vivo complement activation by metal and bioabsorbable screws used in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of the study was to evaluate the biocompatibility of polylactide (PLLA) screws in comparison with standard metal screws for fixation of the patellar tendon graft in human anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 41 patients (22 women and 19 men) were prospectively randomized for the use of metal interference screws (20 patients) or biologically resorbable PLLA screws from Linvatec, Largo, FL (21 patients). Average age at the time of surgery was 26 years (15 to 51 y). Synovial fluid and plasma were collected preoperatively and after 6 weeks in both groups. Plasma was analyzed for C5a and synovial fluid, as well as for terminal SC5b-9 complement complex (TCC) and interleukin (IL)-8. At 1 year after surgery, serum was incubated with metal, PLLA, and no screws; this was followed by analysis of C5a after 1 and 6 hours of incubation. Inflammatory mediators were measured through enzyme-linked immunosorbent assay (ELISA). RESULTS: In the BioScrew group, 4 patient samples showed high C5a concentration in synovial fluid after 6 weeks, but no statistically significant difference was observed between the 2 groups (P = .11). One patient in the BioScrew group had a high TCC value after 6 weeks, but no statistically significant difference was seen between the 2 groups (P = .20). In the in vitro study, no increased C5a generation was observed in sera incubated with a BioScrew or a metal screw compared with controls. CONCLUSIONS: No statistically significant difference was observed between the BioScrew and metal screw groups concerning C5a, TCC, and IL-8 formation. However, some patients in the BioScrew group showed elevated values. LEVEL OF EVIDENCE: Level II, prospective randomized trial.

A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament.

BACKGROUND: This study compares three surgical procedures that we used in the past to treat ruptures of the anterior cruciate ligament: acute primary repair, acute repair augmented with a synthetic ligament-augmentation device, and acute repair augmented with autologous bone-patellar tendon-bone graft. METHODS: This is the third report on a group of patients who were randomized to the three different procedures between 1986 and 1988. There were fifty patients in each group. The patients were evaluated prospectively at one, two, five, and sixteen years with use of the Tegner activity score and the Lysholm functional score. Stability of the knee was assessed with clinical examination and with use of the KT-1000 arthrometer. RESULTS: One hundred and twenty-nine (88%) of the 147 patients who were available for follow-up completed the study. Eleven patients (24%) who had a primary repair, four patients (10%) who had repair with a ligament augmentation device, and one patient (2%) who had augmentation with autologous bone-patellar tendon-bone graft underwent anterior cruciate ligament revisions between the primary operation and the sixteen-year follow-up examination. The rate of revision was ten times higher in the group that had primary repair than in the group that had repair with bone-patellar tendon-bone graft (p = 0.003). In the remaining patients, those who had repair with a bone-patellar tendon-bone graft had significantly more stable knees than those who had repair with a ligament augmentation device, as measured by the Lachman test (p = 0.026). Nine (11%) of the eighty-five patients for whom data were available had osteoarthritis in the primarily reconstructed knee, and three patients (3.5%) had osteoarthritis in the contralateral knee at sixteen years (p = 0.001); no difference was noted among the three groups. The mean Lysholm score at sixteen years was 88 points for the knees that had primary repair, 85 points for those that had repair with the ligament augmentation device, and 90 points for those managed with a bone-patellar tendon-bone graft (p = 0.286). CONCLUSIONS: At long-term (sixteen-year) follow-up, the rate of revision anterior cruciate ligament surgery is much higher following primary repair than after primary repair augmented by a bone-patellar tendon-bone graft. It can be expected that approximately 10% of patients undergoing anterior cruciate ligament reconstruction acutely will have osteoarthritis develop in the reconstructed knee. We no longer perform any of these surgical techniques as open procedures.

Magnetic resonance imaging analysis of bioabsorbable interference screws used for fixation of bone-patellar tendon-bone autografts in endoscopic reconstruction of the anterior cruciate ligament.

BACKGROUND: Metal interference screws can cause problems if revision is needed and can interfere with magnetic resonance imaging. Bioabsorbable screws have been developed to prevent these problems, but the rate of resorption and integration is not well understood. HYPOTHESIS: Poly-L-lactic acid interference screws will be resorbed 2 years after anterior cruciate ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study group consisted of 19 patients with isolated anterior cruciate ligament ruptures reconstructed with bone-patellar tendon-bone autografts fixed with poly-L-lactic acid interference screws using an endoscopic technique. Magnetic resonance imaging was used to evaluate resorption of the screws, bony integration of the screws, and integration of the bone blocks after 2 years. RESULTS: At 2 years, the mean reduction in the volume of the femoral screws was 64% and of the tibial screw was 63%. Bony integration of the femoral bone block was considered good in 17 patients and fair in 2 patients. Integration of the tibial bone block was considered good in 16 patients and fair in 1 patient who demonstrated widening of the tibial tunnel. Osteolysis around the screws was seen in 3 patients in the femur and none in the tibia. CONCLUSION: The mean reduction in volume of the poly-L-lactic acid screws as measured by magnetic resonance imaging after 2 years was approximately two thirds. The integration of the bone blocks was considered good in 90% of the patients. Osteolysis around the screws was visible in 16% of the patients. CLINICAL RELEVANCE: Two years after ACL reconstruction using poly-L-lactic acid interference screws, the surgeon can expect to find approximately one third of the volume of the screw remaining in the bone tunnels.

[Rerupture after operation for total Achilles tendon rupture]. / Reruptur etter operasjon for total akillesseneruptur.

BACKGROUND: Over the period 1991-2000 the postoperative treatment of total Achilles tendon ruptures at St. Olav Hospital was changed from plaster cast during 6 weeks to plaster cast during the first 14 days and subsequently orthosis treatment from 2nd to 6th week postoperatively. The purpose of the study was to analyze the treatment of Achilles tendon ruptures at the department with main emphasis on whether there had been an increase in reruptures and, if this was the case, could it be attributed to the change to orthosis treatment postoperatively. MATERIAL AND METHODS: A questionnaire was mailed to all patients (n = 301) registered in the hospital database during the period 1991-2000 with a diagnosis of rupture of the Achilles tendon. RESULTS: 221 patients returned the questionnaire (73%). In 1991-1995, 16.8% were treated postoperatively with orthosis, compared to 71.9% in 1996-2000. The rerupture frequency had increased from 5.6% to 11.4%, but there was no significant difference in rerupture frequency between those treated with orthosis treated (8.0%) and those treated with plaster only (9.1%). There was no statistically significant difference between the two groups in patient-reported satisfaction with the treatment, nor in the length of sick-leave. INTERPRETATION: These results do not support the possibility that the tendency towards increased number of reruptures is associated with a change in postoperative treatment with orthosis.

Endoscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws: a prospective randomized study of the clinical outcome.

BACKGROUND: During the past decade, bioabsorbable interference screws have become increasingly popular in endoscopic reconstructions of the anterior cruciate ligament. With these screws, there is no need for a second operation for removal and no complicating factor if later revision surgery is necessary. Several pullout studies have found similar results between metal and bioabsorbable interference screws; however, few studies have investigated the clinical outcome. HYPOTHESIS: There is no difference in the clinical outcome of bioabsorbable interference screws compared with metal screws. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Forty-one patients were randomized for the use of either metal interference screws (20 patients) or bioabsorbable poly-l-lactic acid screws (21 patients). The patients were followed with clinical examinations at 6, 12, and 24 weeks and at 1 and 2 years postoperatively. RESULTS: Subjective knee function was better in the patients in the metal screw group; they had less pain at rest, a higher Tegner score, a higher Lysholm score, and better subjective knee function at 2 years compared to the bioabsorbable screw group. However, there was no difference in stability between the groups. CONCLUSION AND CLINICAL RELEVANCE: Because of the inferior results in the bioabsorbable screw group in our study, and until larger studies show otherwise, we do not find the advantages of using bioabsorbable screws sufficient to warrant the routine use of poly-L-lactic acid screws in anterior cruciate ligament reconstructions.

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients.

INTRODUCTION: We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included. MATERIALS AND METHODS: Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails). RESULTS: Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year. CONCLUSION: The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.

Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.

BACKGROUND: New methods have been used, with promising results, to treat full-thickness cartilage defects. The objective of the present study was to compare autologous chondrocyte implantation with microfracture in a randomized trial. We are not aware of any previous randomized studies comparing these methods. METHODS: Eighty patients without general osteoarthritis who had a single symptomatic cartilage defect on the femoral condyle in a stable knee were treated with autologous chondrocyte implantation or microfracture (forty in each group). We used the International Cartilage Repair Society, Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data. An independent observer performed a follow-up examination at twelve and twenty-four months. Two years postoperatively, arthroscopy with biopsy for histological evaluation was carried out. The histological evaluation was done by a pathologist and a clinical scientist, both of whom were blinded to each patient's treatment. RESULTS: In general, there were small differences between the two treatment groups. At two years, both groups had significant clinical improvement. According to the SF-36 physical component score at two years postoperatively, the improvement in the microfracture group was significantly better than that in the autologous chondrocyte implantation group (p = 0.004). Younger and more active patients did better in both groups. There were two failures in the autologous chondrocyte implantation group and one in the microfracture group. No serious complications were reported. Biopsy specimens were obtained from 84% of the patients, and histological evaluation of repair tissues showed no significant differences between the two groups. We did not find any association between the histological quality of the tissue and the clinical outcome according to the scores on the Lysholm or SF-36 form or the visual analog scale. CONCLUSIONS: Both methods had acceptable short-term clinical results. There was no significant difference in macroscopic or histological results between the two treatment groups and no association between the histological findings and the clinical outcome at the two-year time-point. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Anterior cruciate ligament reconstruction with and without a ligament augmentation device : results at 8-Year follow-up.

BACKGROUND: Ligament augmentation devices have been used in anterior cruciate ligament reconstruction since the suggestion of Kennedy et al. in 1980 that such devices would allow grafts to heal faster and more safely. HYPOTHESIS: Patients who had augmentation will have better outcomes after 8 years. STUDY DESIGN: Prospective randomized case control study. METHODS: Between 1991 and 1993, 100 patients were randomized to groups undergoing anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts with (49) or without (51) use of a Kennedy ligament augmentation device. Of these 100 patients, 94 were examined at an average of 8 years after surgery. Fifteen patients were excluded because of rupture in the other knee and 11 because of rerupture in the same knee. RESULTS: Of the remaining 68 patients, the mean Lysholm function score was 84 in the augmentation group and 87 in the control group. There was a statistically significant relationship between preoperatively detected cartilage injury and osteoarthritis. Almost half of the patients had developed osteoarthritis. We observed no significant difference between the two groups concerning rerupture rate, Lysholm or Lachman test scores, or KT-1000 arthrometer measurements. CONCLUSIONS: We found no positive long-term effects supporting the use of augmentation in anterior cruciate ligament reconstruction.