Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis

Abstract

Forty-four patients with symptomatic chronic anterior cruciate ligament instabilities that had been reconstructed with the central one-third patellar tendon and a lateral extraarticular iliotibial band tenodesis were studied at an average followup of 7 years (range, 4 to 10). The cases with associated medial, lateral, or posterior laxity were not included, nor were the cases with more than minimal preoperative degenerative changes. The average age at surgery was 21 years (range, 16 to 33). A postoperative cast was used for 4 weeks. Satisfactory objective stability, which was defined as a KT-1000 side-to-side difference of up to 5 mm at the manual maximum test, was obtained in 37 (84%) of the patients. In 25 patients (57%), stability was restored within normal limits (less than or equal to 3 mm). No deterioration of the KT-1000 stability was noted at two follow-up visits performed by the same examiner (at an average of 4 and 7 years). A return to high-risk sports was possible in 27 (62%) of the patients. Difficulties in regaining a complete range of motion were recorded in 5 (11%) of the patients. A flexion contracture of 5 degrees to 7 degrees was also found in 5 patients. Significant patellofemoral symptoms were present in 4 patients (9%). A 5% to 11% shortening of the patella tendon was observed in 14 (32%) of the knees, but did not correlate with patellar problems. Moderate radiographic changes were noted in eight patients (18%) at followup and correlated with meniscectomy and pain. Overall satisfactory results were obtained in this initial experience in 29 (66%) of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Patellar tendon vs. doubled semitendinosus and gracilis tendon for anterior cruciate ligament reconstruction

“…Limitation of extension used to be a problem [1,3], but with the current rehabilitation using early mobilisation and passive full extension, the problem is minimized. We found no cases with more than 5°of extension loss irrespective of group.…”

Strain rate effect on the mechanical behavior of the anterior cruciate ligament–bone complex

“…If the knee is not treated to restore its initial stability, degenerative changes in the articular cartilage are possible [2]. The surgical treatment of an ACL deficient knee has then become a routine procedure; despite its frequency, however, its success is inconsistent [3].…”

Extraarticular transposition of the patellar tendon for anterolateral instability of the knee:Poor results in 52 patients after 5-14-year follow-up

“…Howe et al (1991), in their 6-year follow-up of 70 patients reconstructed intraarticularly with quadriceps-patellar tendon grafts, found a recurrence of instability in one fifth of the patients. Aglietti et al (1992) reinforced their intraarticular bone-patellar tendon-bone grafts with an extraarticular iliotibial band tenodesis. After a mean 7-year follow-up of 44 patients, they found anterior instabiity in one third of the patients.…”