title: Long-term followup of anterior cruciate ligament reconstruction using the quadriceps tendon substitution for chronic anterior cruciate ligament insufficiency.
abstract: At The Hospital for Special Surgery, the quadriceps tendon substitution (QTS), as described by Marshall, was performed for ACL insufficiency from 1973 to 1980. A review of the initial 60 patients with a minimum of 4 years followup (average, 5.5 years) has been concluded. Thirty-eight patients returned for examinations, and 11 returned questionnaires. Associated medial procedures were performed in 29 of the 38 examined patients. Medial meniscus surgery was performed in 86% and lateral meniscus surgery in 28.9%. At followup, giving way, which was the main preoperative complaint, was eliminated in 30/38 examined and 9/11 questionnaire patients (79%). In the examined group, three patients were clear failures and five had mild transient instability. The pivot shift was present in 17 of 38 (45%) patients examined: 21 patients were negative, 9 were 1+ or a grind, 8 were 2+, and none were 3+. We have concluded that the QTS procedure will eliminate symptomatic instability in 79% of our patients, but the high rate of a residual pivot shift (45%) and symptoms of instability (21%) require the addition of an extraarticular sling procedure. This appears to be related to the relatively poor strength characteristics of the tissue used in the QTS substitution.
authors.affiliation: Sports Medicine Department, Hospital for Special Surgery, New York, NY 10021.
authors.forename: I
authors.initials: I
authors.lastname: Kornblatt
authors.forename: R F
authors.initials: RF
authors.lastname: Warren
authors.forename: T L
authors.initials: TL
authors.lastname: Wickiewicz
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000601:surgery; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D011184:Postoperative Period; D013709:Tendon Transfer; D000070600:Tibial Meniscus Injuries; D013997:Time Factors