PROSPECTIVE ANALYSIS OF 104 ANTERIOR CRUCIATE LIGAMENTOPLASTIES USING THE FASCIA LATA AT A MEAN FOLLOW-UP OF 27 MONTHS

Abstract

Purpose: The prospective study conducted by an independent examiner included an overall series of 104 ligamento-plasties using the fascia lata (Jaeger procedure).

Material and methods: All procedures were performed by the same operator and outcome was assessed at least 12 months after operation (mean follow-up 27 months).

Results and discussion: The IKDC scores were comparable with other series using autotransplants: 39% A, 45% B, 12% C, 4% D. Mean residual laxity differential (KT 2000) was 1.92 mm (−2 to 6 mm) and showed the anatomic efficacy of this technique. Extra-articular reinforcement was determinant in supporting the intra-articular plasty, calibrated at 6 mm diameter, explaining the good score obtained for residual differential laxity in sub-extension: 54% A, 29%B, 3%C. Laxity measured between +2 and +3 mm in 14% of the patients who could not be classed in the IKDC A and B classes. Mixed plasty with the fascia lata neutralised rotation clicks in 90.4% of the cases. The lateral portion of the mixed plasty did not raise any problem for ligamentisation explaining its efficacy and low rate of rotation clicks at last follow-up.

All professional athletes in this series and all athletes participating in high-level competitions were able to resume their former sports activity at the same level; for the entire series 67% resumed their former sports activities at the same level. Thirty-eight competition level athletes (n=63, 60%) resumed competition after surgery, 24 (38%) practised leisure sports. The change to leisure sports in these 24 patients was related to the knee plasty in eight. Irreducible knee flexion (+5°) was related to reflex dystrophy in four patients. Eleven patients presented reflex dystrophy; two had mobilisation under general anaesthesia.

None of the patients had a painful harvesting site. Among the four cases with lateral decoaptation, two were related to poor dissection of the posterolateral angle without any pre-existing lesion of the peripheral formations.

Section of the lateral intermuscular partition allowed complete closure of the fascia lata in all the difficult cases. We had only one case of proximal muscular herniation at the harvesting site.