Thirty-nine subjects volunteered for this blinded, randomized, and controlled study to assess the clinical examination skills of orthopaedic surgeons with fellowship training in sports medicine. Eighteen of the patients had 19 chronic isolated posterior cruciate ligament tears. The controls were 9 patients with 9 anterior cruciate ligament-deficient knees, 12 subjects with normal knees, and the contralateral normal knees of the ligament-deficient patients. To eliminate preexamination bias, all examiners were blinded from the examinee's history, identity, and diagnosis. The overall clinical examination accuracy for all orthopaedic surgeons was 96%. The accuracy for detecting a posterior cruciate ligament tear was 96%, with a 90% sensitivity and a 99% specificity. The examination accuracy was higher for grade II and III posterior laxity than for grade I laxity. Eighty-one percent of the time, the examiners agreed on the grade of the posterior cruciate ligament tear for any given patient. The posterior drawer test, which included palpation of the tibia-femur step-off, was the most sensitive and specific clinical test. A thorough and precise physical examination, coupled with a patient history, can be considered diagnostic in the majority of isolated posterior cruciate ligament injuries. With this accuracy level known, the natural history of isolated posterior cruciate ligament tears can be reliably documented and studied.

To distinguish between morbidity caused by the isolated patellar tendon graft harvest and morbidity associated with anterior cruciate ligament reconstruction when the graft is harvested from the involved knee, we studied 20 patients who had an isolated contralateral graft harvest for anterior cruciate ligament reconstruction in the opposite knee. We defined and quantitated the morbidity by evaluating the uninjured knee from preoperative studies to current followup (range, 0.5 to 5 years; average, 2 years). All graft harvest surgeries were performed in an identical fashion. Rehabilitation of the harvest knee included immediate range of motion, weightbearing, and closed chain kinetic exercises with a emphasis on early strengthening. All patients regained full knee range of motion by 3 weeks. At final followup, there was no clinical or radiographic evidence of patella contracture or baja. Quadriceps strength averaged 69% at 6 weeks and returned to 93% at 1 year and 95% at 2 years. Activity-related soreness at the donor site (patellar tendinitis) was rarely restricting and resolved after the 1st year. No patient complained of patellofemoral joint pain in the donor knee. The modified Noyes subjective questionnaire score averaged 97 of 100 at last followup. The morbidity of an isolated autogenous patellar tendon graft harvest appears to be of short duration and largely reversible.

We sought to determine if knee stability after autogenous bone-patellar tendon-bone anterior cruciate ligament reconstruction was adversely affected by obtaining immediate full hyperextension. We selected patients based on degree of knee hyperextension. Group 1 (46 men and 51 women), with an average of 10 degrees (range, 8 degrees to 15 degrees) hyperextension, was compared with the randomly selected control Group 2 (70 men and 27 women), which had an average of 2 degrees (range, 0 degrees to 5 degrees) hyperextension. The operative knee in both groups, which underwent similar reconstruction of the injured knee, achieved full passive extension equal to the non-involved knee during the immediate postoperative course. The average KT-1000 arthrometer manual maximum side-to-side differences were 2.4 mm for Group 1 and 2.1 mm for Group 2 (P = 0.13). Seventy-nine patients in Group 1 had KT-1000 arthrometer differences of < or = 3 mm as compared with 85 patients in Group 2. Fourteen patients in Group 1 had KT-1000 arthrometer differences of 4 or 5 mm as compared with eight patients in Group 2. Four patients in each group had KT-1000 arthrometer differences > 5 mm. Evidence suggests that restoring and maintaining immediate full knee hyperextension after this type of reconstruction does not adversely affect the ultimate stability of the knee.

We sought to evaluate the accuracy with which joint line tenderness is associated with meniscal lesions in knees with acute anterior cruciate ligament tears. The physical assessment of joint line tenderness was performed at a mean of 8 days after the initial injury in 173 patients who subsequently underwent anterior cruciate ligament reconstruction. Identification of meniscal lesions was documented at the time of anterior cruciate ligament reconstruction. Eighty-nine patients (51%) had medial joint line tenderness; of this subgroup, 40 (45%) had a medial meniscal tear. Eighty-four patients (49%) had no medial joint line tenderness; of this subgroup, 29 (35%) had a medial meniscal tear. Fifty-nine patients (34%) had lateral joint line tenderness; of this subgroup, 34 (58%) had a lateral meniscal tear. One hundred fourteen patients (66%) had no lateral joint line tenderness; of this subgroup, 56 (49%) had a lateral meniscal tear. Medical joint line tenderness was 44.9% sensitive and 34.5% specific predicting medial meniscal injury. Lateral joint line tenderness was 57.6% sensitive and 49.1% specific in predicting lateral meniscal injuries. Therefore, we determined that the presence or absence of joint line tenderness in patients with an acute anterior cruciate ligament tear is not a reliable criterion to predict the likelihood of an associated meniscal tear.

One hundred twenty-one patients were prospectively studied to determine whether the different remaining patellar tendon widths after central 10-mm bone-patellar tendon-bone graft harvest influenced the rate and level of quadriceps strength achieved during rehabilitation. Size of the patellar tendon width, measured at the same location in each patient, ranged from 24 to 35 mm. For this study, patients were grouped according to their remaining tendon size into small (14 to 17 mm; mean, 15.8), medium (18 to 20 mm; mean, 19.2), and large (21 to 25 mm; mean, 22.5) widths. Postoperatively, the patient's isokinetic quadriceps scores were determined at 6 weeks, 3 months, 6 months, and 1 year. At 6 weeks, the small- and medium-width tendon groups were significantly weaker than the large-width tendon group. At 3 months, only the small-width tendon group continued to be significantly weaker than the large-width tendon group. At and beyond 6 months, no statistically significant differences were seen between remaining patellar tendon width groups and their isokinetic quadriceps scores. A constant-sized autogenous patellar tendon graft may be harvested for anterior cruciate ligament reconstruction without compromising ultimate postoperative quadriceps strength recovery.