Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft Followed by Accelerated Rehabilitation

Abstract

We sought to determine the long-term results of 1057 consecutive patients who underwent an anterior cruciate ligament reconstruction with an autogenous patellar tendon graft from 1987 through 1993 and who followed an accelerated rehabilitation program. The patients were followed prospectively and objective physical examination data were obtained on 806 patients at a mean of 4.0 years postoperatively. Subjective follow-up data were obtained on 948 patients at a mean of 4.4 years postoperatively. The mean final range of motion was 5 degree/0 degrees/140 degrees. The mean manual maximum KT-1000 arthrometer score was 2.0 +/- 1.5 mm. Isokinetic quadriceps muscle strength testing revealed a mean of 94% strength after acute reconstructions and 91% strength after chronic reconstructions. International Knee Documentation Committee evaluation after acute reconstruction rated 42% of knees as normal, 47% as near normal, 10% as abnormal, and 1% as severely abnormal. The same evaluation after chronic reconstruction rated 41% of knees as normal, 44% as near normal, 14% as abnormal, and 1% as severely abnormal. Radiographically, 94% of acute knees and 89% of chronic knees had no joint space narrowing. Subjective modified Noyes questionnaire results showed a mean score of 93.2 +/- 7.9 points. The mean time for patients to return to sport-specific activities was 6.2 weeks and to athletic competition at full capacity was 6.2 months postoperatively. In the long-term, patients exhibited full range of motion, excellent stability, good strength, and a return of full function in most cases.

Return to sport following anterior cruciate ligament reconstruction

“…For instance, although the mean times to resume pre-injury sport were 3.8 and 6.4 months for double-bundle and single-bundle ACL reconstruction in a study by Zaffagnini et al, the range was three to 24 months [52]. Similarly, Shelbourne and Gray reported a mean time to return to competition at full capability of 6.2 months, but a range of two to18 months [40]. In both studies the patients participated in varying levels of sport, competitive and recreational, making it difficult to extrapolate from the results.…”

Hamstring graft size and anthropometry in south Indian population

“…21,22 The biomechanical strength of the 7 mm diameter, 3, or 4 strand graft is approximately 240% greater than that of the native anterior cruciate ligament. 23e26 Grafts with smaller diameters are weaker than this, which will compromise the graft integrity and ultimately clinical outcome.…”

Validation of the 65° Howell Guide for Anterior Cruciate Ligament Reconstruction

“…The medial and lateral limits of the attachment were at -3±1[-5-(-2)] mm and +6±2 (3)(4)(5)(6)(7)(8)(9) mm respectively lateral to the medial tibial spine. The tibial attachment was on average 17±2(12-19) mm long and 9±2(7-16) mm wide.…”

“…Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure and satisfactory results are achieved in the majority of cases 1,2,3,4,5 . Despite the range of grafts and fixation devices employed, correct tunnel placement remains the main determinant of the final outcome 6,7 and a malpositioned tunnel is likely to result in instability or in lack of recovery of the range of motion 8,9,10,11 .…”