Anterior cruciate ligament reconstruction in patients who have excessive joint laxity.
BACKGROUND
The purpose of the present study was to compare the clinical results of anterior cruciate ligament reconstruction with use of different grafts in patients with or without excessive joint laxity.


METHODS
We retrospectively studied eighty-three patients (forty-eight men and thirty-five women) who had undergone anterior cruciate ligament reconstruction between June 2002 and August 2004. Of the thirty-one patients who had generalized joint laxity, twenty were managed with an autologous bone-patellar tendon-bone graft and eleven were managed with a four-bundle hamstring (semitendinosus-gracilis tendon) graft. Of the fifty-two patients who had normal joint laxity, thirty-three were managed with a bone-patellar tendon-bone graft and nineteen were managed with a hamstring graft. Clinical results were evaluated by means of an examination at a minimum of twenty-four months after surgery.


RESULTS
Among the patients who had normal joint laxity, the mean side-to-side difference in anterior tibial translation on testing with the KT-2000 arthrometer at a minimum of twenty-four months postoperatively was 2.7 +/- 1.9 mm in the bone-patellar tendon-bone graft group and 3.5 +/- 1.7 mm in the hamstring graft group. This difference was not significant. The mean Lysholm score was 91 +/- 7 points in the bone-patellar tendon-bone graft group and 85 +/- 10 points in the hamstring graft group (p = 0.492). The side-to-side difference in anterior translation had an inverse correlation with the Lysholm score (beta = -0.604, p < 0.001). Among the patients who had excessive joint laxity, the mean side-to-side difference in anterior tibial translation was 3.4 +/- 1.5 mm in the bone-patellar tendon-bone graft group and 4.5 +/- 2.0 mm in the hamstring graft group (p = 0.036). The mean Lysholm score was 89 +/- 7 points in the bone-patellar tendon-bone group and 79 +/- 12 points in the hamstring group (p = 0.015). The side-to-side difference in anterior translation had an inverse correlation with the Lysholm score (beta = -0.708, p < 0.001).


CONCLUSIONS
In patients who have excessive joint laxity, the two-year outcomes of anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts are better than those with four-bundle hamstring grafts in terms of both side-to-side anterior laxity and clinical results.
Kim
Sung-Jae
SJ
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Shinchon-dong, Seodaemoon-gu, 120-752, Seoul, Republic of Korea.
Kim
Tae-Eun
TE
Lee
Doo-Hyung
DH
Oh
Kyung-Soo
KS
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D050376:Bone-Patellar Tendon-Bone Grafting; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome