Reconstruction of the chronically lax anterior cruciate ligament using the middle third of the patellar tendon. A 3-9 year follow-up.
After an average of 5 years, the authors reviewed 76 cases of anterior cruciate ligament reconstruction in which the middle third of the patellar tendon had been used as a free autogenous graft. A lateral Lemaire operation had been used in 85% of the cases and postoperative cast immobilization in 72%. Functional knee instability was eliminated in 96% of the patients. Pain was present at the follow-up in 14.5% of the patients and correlated with both meniscectomy (p = 0.03) and the presence of degenerative changes on the radiographs (p = 0.002). The pivot-shift was eliminated in 93% of the cases and the maximum manual test performed with the KT-1000 arthrometer was less than or equal to 5 mm in 83%. Lateral compartment laxity which was not corrected at operation was frequently associated with graft failure (p = 0.01). Seven patients had difficulty in rehabilitation, and in 6 of these the final result was unsatisfactory. Pain and swelling in the femoropatellar joint were present in 8% of the cases. Slight and moderate degenerative changes were shown on the radiographs in 48% and 10% of the patients, respectively, at follow-up; these findings correlated with meniscectomy (p less than 0.001) and rehabilitation problems (p = 0.03). This procedure achieved lasting, satisfactory results in 70% of the cases. Additional advances include greater care in positioning the graft, use of arthroscopy, and early mobilization. Further studies are needed to verify the advantages of these new techniques.
Aglietti
P
P
I Clinica Ortopedica dell'Università, Firenze, Florence.
Buzzi
R
R
D'Andria
S
S
Pisaneschi
A
A
Zaccherotti
G
G
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007717:Knee / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D013709:Tendon Transfer; D016896:Treatment Outcome