The results of intraarticular anterior cruciate ligament reconstruction with either the patellar tendon or the semitendinosus and gracilis tendons (four strands) were prospectively compared in a consecutive series of 60 patients with chronic injuries. A single surgeon performed arthroscopically assisted reconstructions in an alternating sequence. Preoperative and operative data revealed no significant differences between the two groups. After 28 months of followup there were no significant differences in the incidence of symptoms, and recurrent giving way was present in only one knee with semitendinosus and gracilis tendon graft. Return to sport participation was more frequent in the patellar tendon group (80% versus 43%, P < 0.01). A minor extension loss (< or = 3 degrees) was more frequent in the patellar tendon group (47% versus 3%, P < 0.001). Other differences between the two groups were not significant. KT-2000 arthrometer side-to-side difference of anterior displacement > 5 mm at 30 pounds was present in 13% of the knees with patellar tendon grafts and in 20% of those with semitendinosus and gracilis; a patellofemoral crepitation developed in 17% and 3% of the two groups, respectively. Based on these data we routinely use patellar tendon grafts. Semitendinosus and gracilis tendons are preferred in selected cases: older patients, patients with preexisting patellofemoral problems, and those with failed patellar tendon grafts.

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We performed a comparative study of two series of 25 patellar tendon arthroscopic reconstructions of isolated chronic anterior cruciate ligament injuries, alternating between a double-incision (using a rear-entry guide) or single-incision technique (using a transtibial approach). The patients were reviewed to assess the clinical, KT-2000 and radiological differences at an average follow-up of 14 months (range 8-18 months). For the clinical evaluation the International Knee Documentation Committee Form was used. The following radiographic parameters were measured: (1) the direction of the femoral and tibial tunnels in the antero-posterior (AP) and lateral (LL) views; (2) the location of the anterior border of the intra-articular exit hole of the femoral tunnel in the LL radiologic view; (3) femoral interference screw divergence with the bone block. An extension loss < or = 5 degrees was detected in 40% of the double-incision and 36% of the single-incision patients (NS). A flexion loss < or = 10 degrees was present in 8% of the double-incision and 16% of single-incision group (NS). There were no differences in terms of pivot shift test between the two groups (pivot glide in 12% of both groups). The average side-to-side KT-2000 differences at the manual maximum test were 1.98 mm in the double-incision and 2.64 mm in the single-incision group. With the double-incision technique the femoral and tibial tunnels were divergent in the AP plane and crossed the joint at an angle of 37 degrees and 72 degrees, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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