Abstract
Purpose: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) with a free patellar tendon graft is a classical method for the treatment of anterior knee laxity. The purpose of this study was to analyse clinical and radiological outcome in 218 cases at five years and to search for prognostic factors.
Material and methods: Between 1993 and 1994, arthroscopic repair of the ACL was performed in 218 knees with two independent tunnels using a free patellar graft. This prospective study included 177 knees reviewed at a mean 67±7 months follow-up using the IKDC criteria and instrumental manual KT-1000 laxity measurements. The series included 67.4% men and 32.6% women, mean age 26.7 years (14–59). Delay from the accident to surgery was a mean 22.3 months (1–228 months). Two medial, 15 lateral and five medial and lateral meniscectomies had been performed before the operation studied. The position of the tunnels was studied using the Aglietti method. Differences were considered significant at p < 0.05.
Results: Sports activities could be resumed in 87% of the cases at the same level for 62% with a mean delay of 12 months. Subjectively, the patients were satisfied or very satisfied in 86% of the cases. Symptom score was A in 50%, B in 38%, C in 8.3% and D in 3.7%. Maximal manual residual differential measured with KT-100 was 0.75 ± 2.3 mm with an abolished click in 82% of the cases and a glide in 12%. Sceondary medial meniscectomy was performed in 19 cases. At last follow-up the meniscal material was intact in 127 cases (60%). Overall IKDC score for the 177 cases reviewed was: A 57%, B 24%, C 9%, D 9%. Radiographically, the knee was normal in 66.6% of the cases, remodelled in 29.6%, and exhibited joint space narrowing less than 50% in 13.4% and overall osteoarthritis in 0.6%. The Aglietti lateral score as 25.5±7% for the tibia and 66.3±7.2% for the femur. During follow-up, there were 13 cases of recurrent tears related to repeated sports trauma or poor femoral position. During this same period, there were 20 tears of the contralateral ACL. Functional outcome was correlated with the presence of a medial meniscus, the length of delay from accident to surgery, and the presence of radiological evidence of residual laxity.
Conclusion: This study demonstrated that chronic anterior laxity of the knee, treated with a free patellar tendon graft implanted arthroscopically provides good restoration of the knee in 82% of the cases with little residual laxity. Joint space narrowing was found in 1% of the cases and was strongly correlated with the status of the medial meniscus that should be preserved. The number of recurrent tears was equivalent to the number of contralateral tears observed during the same period.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
