A randomised controlled trial was performed to compare the clinical outcome for the two commonest types of anterior cruciate ligament (ACL) reconstruction. Methods: Patients undergoing elective anterior cruciate reconstruction were randomised into one of two groups. Group PT underwent reconstruction using a patella tendon autograft (n=14), whereas Group SG had a semitendinosus/gracilis autograft (n=18). The same surgeon performed all operations. IKDC self reported function and activity scores were recorded pre-operatively and at one and five years post operation. KT1000 values and muscle strength were recorded pre-operatively and one year post operation.

Results: No significant difference between groups was found for any measurement at one year despite adequate study power. At five year follow up patients in the PT group had superior scores in every category of the IKDC self reported function score (mean IKDC score for PT group = 83, mean IKDC score for SG = 75). The activities of squatting and kneeling revealed the greatest difference between groups. It was found that 71% of patients in the PT group achieved IKDC scores of 80 or over whereas only 61% of patients in the SG group achieved 1 KDC scores of 80 or over.

Conclusion: The study indicates that both techniques produce acceptable outcome for anterior cruciate ligament reconstruction but use of the patella tendon autograft may provide slightly more favourable results, especially for activities involving squatting and kneeling.

Percutaneous repair of the ruptured tendo Achillis has a low rate of failure and negligible complications with the wound, but the sural nerve may be damaged. We describe a new technique which minimises the risk of injury to this nerve.

The repair is carried out using three midline stab incisions over the posterior aspect of the tendon. A No. 1 nylon suture on a 90 mm cutting needle approximates the tendon with two box stitches. The procedure can be carried out under local anaesthesia.

We reviewed 27 patients who had a percutaneous repair at a median interval of 35 months after the injury. They returned to work at four weeks and to sport at 16. One developed a minor wound infection and another complex regional pain syndrome type II. There were no injuries to the sural nerve or late reruptures. This technique is simple to undertake and has a low rate of complications.

We treated 90 patients with an isolated injury to the anterior cruciate ligament (ACL) by reconstruction using a patellar tendon autograft and interference screw fixation.

Of these, 82 (91%) were available for review at 24 months. Two grafts and two contralateral ACLs had ruptured during sport and there was one case of atraumatic graft resorption. Using the assessment of the International Knee Documentation Committee (IKDC), 86% of the remaining patients were normal or nearly normal. The median Lysholm knee score was 95/100 and 84% of patients were participating in moderate to strenuous activity. All had grade-0 or grade-1 Lachman, pivot-shift and anterior-drawer tests. Measurement with the KT1000 arthrometer gave a side-to-side difference of < 3 mm of anterior tibial displacement in 90%. Sixty-six radiographs were IKDC grade A and one was grade B. Pain on kneeling was present in 31% and graft site pain in 44%.

At 24 months after operation all patients had excellent knee stability, a high rate of return to sport and minimal radiological evidence of degenerative change. Our series therefore represents a basis for comparison of results using other techniques and after more severe injuries.