Seventy patients were evaluated after combined intra- and extraarticular reconstruction of the anterior cruciate ligament. Semitendinosus and gracilis tendons were used for the intraarticular reconstruction and Losee iliotibial band tenodesis for the extraarticular procedure. Minimum followup was 5 years (average, 7). Clinical examination and instrumented ligament examination with the KT-1000 arthrometer and the Cybex II dynamometer were used to evaluate results. Subjectively, patients had no complaints of instability with daily activities; 93% had no complaints of instability with athletic participation. Clinical examination demonstrated that 81% had less than a 1 + Lachman test; 98% had a negative pivot shift. Instrumented examination of the anteroposterior limits of motion revealed that only 57% had less than 3-mm side-to-side difference; 30% had 3- to 5-mm; and 13% had 6- to 9-mm. Mean hamstring muscle strength measured with the Cybex II dynamometer was 94% at 60 and 96% at 100 deg/sec. When evaluated with the Zarins scale, 90% were rated good or excellent, 6% fair, and 4% poor. This reconstructive procedure restores functional, but not necessarily normal, stability in most anterior cruciate ligament-deficient knees. It allows patients to increase activity levels without significant risk of additional injuries.

This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).