Purpose: Anterior cruciate ligament (ACL) repair is increasingly performed to allow athletes reach their earlier sports performance or higher, leading to the risk of repeated tears. Several grafts can be proposed: the contralateral patellar ligament, hamstring tendons and the rectus femoris tendon. The purpose of this study was to analyse results in a continuous series of repeated tears of the ACL repaired with the rectus femoris tendon.

Material and methods: Forty patients underwent surgical repair of the ACL after iterative tears between January 1998 and June 2000. All had had a patellar tendon graft. All were active athletes, 70% at a competition level. The second tear had occurred a mean two years after the first repair. A second graft was indicated because of persistent knee instability. Preoperative laxity was demonstrated with telos at 20 kg showing a mean differential of 12.2 mm with the healthy knee (range 5–25). The arthroscopic technique described by P. Chambat was used. A strand of the rectus femoris tendon was harvested with its bony patellar attachment. The graft was introduced laterally to medially with fixation in the tibial bore hole with a resorbable interference screw. The patellar bone was press fit into the femoral hole.

Results: Outcome was assessed in all patients at mean two years (range 1–3) using telos at 20 kg. Two vertical fractures of the patella occurred three months after the ACL repair subsequent to minimal trauma. Only 50% of the patients resumed competition level sports. Two patients out of 40 had a sensation of unstable knee. Mean residual differential laxity was 2.6 mm (range 0–9).

Discussion: Repair of the ACL with the rectus femoris tendon appears to provide satisfactory results after repeated tears. The thickness, width and stiffness of the tendon allow satisfactory repair even in case of severe laxity. The surgical technique is not particularly difficult if the prior surgery did not produce bony damage and if the bore holes are positioned correctly. The postoperative period is not different than after first intention ligamento-plasty. Complications are minimal. This type of graft can be used for ligamentoplasty of the central pivot. The major complication is the risk of patellar fracture which can be avoided by careful graft harvesting during the first intention procedure. Control of knee laxity can be improved by inverting the graft and fixing the patellar fragment in the tibia and the proximal tendon in the femur.