title: An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes.
abstract: OBJECTIVE
  A positive glide is a common finding after ACL reconstructions, especially in women. The aim of this study was to prospectively evaluate the role of Cocker-Arnold's extra-articular procedure in reducing the incidence of a residual postoperative rotational knee laxity.
  
  
  METHODS
  Sixty patients affected by an ACL injury with a +2 (clunk) or +3 (gross shift) pivot-shift test entered this prospective study; they were randomly assigned to group A (control group, hamstrings) or group B (study group, hamstrings plus Cocker-Arnold). Thirty-two patients entered group A and 28 group B. At follow-up, patients underwent clinical evaluation, KT-1000 arthrometer and Lysholm, Tegner, VAS and subjective and objective IKDC form.
  
  
  RESULTS
  At a mean follow-up of 44.6 months, the same expert surgeon reviewed 55 patients (28 group A and 27 group B). The comparison of the results of the evaluation scales used and of the KT-1000 arthrometer did not show statistically significant differences (p>0.05). Lachman test was negative (S/S) in all the patients of both groups (100 %). A residual positive pivot-shift (glide) was found in 16 patients (57.1 %) of group A and in five patients (18.6 %) of group B (p<0.05).
  
  
  CONCLUSIONS
  The extra-articular MacIntosh procedure modified by Cocker-Arnold in combination with ACL reconstruction significantly reduces the rotational instability of the knee.
authors.affiliation: Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via Grottarossa 1035, Rome (RM), Italy. anto.vada@libero.it
authors.forename: Antonio Pasquale
authors.initials: AP
authors.lastname: Vadalà
authors.forename: Raffaele
authors.initials: R
authors.lastname: Iorio
authors.forename: Angelo
authors.initials: A
authors.lastname: De Carli
authors.forename: Alberto
authors.initials: A
authors.lastname: Bonifazi
authors.forename: Carlo
authors.initials: C
authors.lastname: Iorio
authors.forename: Andrea
authors.initials: A
authors.lastname: Gatti
authors.forename: Cristina
authors.initials: C
authors.lastname: Rossi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferretti
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D011446:Prospective Studies; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult