[Reconstruction of acute anterior cruciate ligament rupture by suture and semitendinosus tendon augmentation.].
OBJECTIVE
Restoration of normal knee function.


METHODS
Acute avulsion of the anterior cruciate ligament (ACL) from its femoral origin.


METHODS
Mid substance and remote tears.


METHODS
Supine. Knee flexed, hip bent to 30 degrees . General or regional anaesthesia.


METHODS
Step 1: Arthroscopy to confirm site of rupture, meniscus repair if necessary. Step 2: Mobilisation of semitendinosus tendon, left attached distally. Step 3: Mini-arthrotomy, securing of ACL stump with atraumatic suture. Step 4: Transfer of ST-tendon through 5 mm drill holes through tibial head and lateral femoral condyle. Step 5: Fixation of tendon and ACL-sutures with staple at the exit of the femoral drill hole.


METHODS
Knee orthosis for 6 weeks, CPM, physiotherapy. ROM day 0-2: 0-10-10 degrees ; day 3-11: 0-0-60 degrees , day 12-42: 0-0-90 degrees . Increase of weight bearing 10 kg/week from operation date. Bicycling and running permitted 3 months post-op. Full sport activity after muscle power has reached that of opposite side. LMW heparin until full weight bearing.


METHODS
Thrombosis. Embolism. Infection. Failure of reconstruction. Osteoarthritis.


RESULTS
During 1 year, 116 patients were operated. Follow-up after 42 to 57 months (average 52 months) included 95 patients (82%). Of these, 76 underwent full examination (average age 33 1/2 years, 20-49 years), 11 answered a questionnaire, 8 had suffered re-injury. Average Lysholm score was 92 points (+/-13). Tegner activity scale amounted to 7.2 points pre-injury, 7.1 points at follow-up. Anterior translation (KT 1000 arthrometer testing at 89 N) was identical to opposite side in 25 patients, less than 2 mm in 14, up to 4 mm in 19, up to 6 mm in 15, more that 6 mm in 3 patients. Pivot shift was negative or trace 73 times, and positive in 3 patients. ROM was full in 54 patients, 17 times the flexion was limited up to 10 degrees . Ten times extension lag was less than 5 degrees , and twice between 5 and 10 degrees .
Kühne
J H
JH
Orthopädische Klinik und Poliklinik der LMU-München, Klinikum Großhadern, Marchioninistraße 15, D-81377, München.
Krüger-Franke
M
M
Refior
H J
HJ