[The results after 10-16 years of the treatment of chronic anterior laxity of the knee using reconstruction of the anterior cruciate ligament with a patellar tendon graft combined with an external extra-articular reconstruction].
OBJECTIVE
The aim of this prospective study was to evaluate the objective postoperative laxity and functional results with a minimum follow-up of 10 years (mean 11.7 +/- 2 years) in chronic anterior knee instability treated by ACL reconstruction associated to a lateral extra-articular plasty.


METHODS
138 patients of a mean age of 27.8 +/- 8.5 years had been operated. Delay between injury and operation was 4 +/- 4.8 years. The surgical "Mac Injones" procedure used a free autologous patellar tendon graft with a bone-to-bone fixation, supplemented by a lateral extra-articular plasty using a strip of quadriceps tendon as a direct prolongation of the graft of the patellar tendon and patella itself. A rehabilitation program aimed to an early recovery of a complete range of motion. Anterior laxity had been measured before and after operation using two instrumented methods, KT-1000 and stress-radiography (at 20 degrees of flexion with a 9 kg load applied at the distal part of the thigh) with measurements of the displacement in medial and lateral compartments. Tunnel positioning was appreciated radiologically. Function was evaluated using the International Knee Documentation Committee score (I.K.D.C.).


RESULTS
Elongation of the reconstructed ligament occurred mainly during the first 6 month, but was independent from early full range of motion recovery. Laxity was stabilized after one year. The final laxity gain of the medial compartment was 62 per cent and for the lateral compartment 77 per cent. The pivot shift test was negative in 66 per cent, grade 2 in 4 per cent, grade 1 in 30 per cent. Functional results were excellent and good (A and B) in 60.4 per cent and 76.7 per cent returned to sports activity. 12 reconstructed ligaments reruptured. Arthritis was the cause of poor results in other cases (13.8 per cent).


CONCLUSIONS
Lateral extra-articular plasty is unable to better control translation of the medial compartment than isolated anterior cruciate ligament reconstruction, but laxity of the lateral compartment was minimized and the pivot shift test also. Incorrect position of the anterior cruciate ligament was correlated with poor results.


CONCLUSIONS
This documented study on laxity of the two compartments confirms the interest of each type of reconstruction, in particular extra-articular plasty when made with quadriceps tendon and so doing, preserving the iliotibial-band for the control of varus stability.
Lerat
J L
JL
Service de Chirurgie Orthopédique et de Médecine du Sport, Centre Hospitalier Lyon-Sud.
Chotel
F
F
Besse
J L
JL
Moyen
B
B
Binet
G
G
Craviari
T
T
Brunet-Guedj
E
E
Adeleine
P
P
Nemoz
J C
JC
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001168:Arthritis / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D007718:Knee Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000637:transplantation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012421:Rupture; D013314:Stress, Mechanical; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome