Reconstruction of the anterior cruciate ligament using a patellar tendon autograft. A long term follow up.

Three hundred and eighty-four athletes with chronic anterior cruciate instability were treated by a free autologous graft of the lateral third of the patellar tendon. Evaluation 5 to 9 years after operation was carried out in 334 cases by physical examination, the KT-1000 arthrometer and the Tegner and Lysholm scoring scale. There were 89.5% satisfactory results and 10.5% were unsatisfactory. Global instability, advanced osteoarthritis and restricted movement after operation were the reasons for a poor outcome. In 9 cases, histological examination showed good incorporation of the graft.

Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty.

We used the MacIntosh over-the-top repair combined with a popliteal tendon plasty in 273 athletically active patients with chronic incapacitating functional instability due to anterior cruciate ligament rupture; 244 were reviewed at three to nine years after operation. We describe the technique and its results, with functional evaluation by the Tegner and Lysholm system. Excellent or good results were obtained in 71%; most of the 29% fair or poor results were due to extensive meniscal and degenerative changes. In a group of 11 patients with excellent results arthroscopic and histological findings were encouraging, showing good incorporation of the graft.

Cruciate ligament replacement using a meniscus. An experimental study.

In 30 rabbits, the medial meniscus was used to replace the anterior or posterior cruciate ligament. The changes that took place were followed in histological sections, obtained both from the area of insertion into bone and from the intra-articular part of the graft. There was a gradual differentiation to chondroid tissue, with subsequent calcific deposition and no appearance of normal ligamentous tissue. The strength of the graft after 52 weeks was only one-quarter of that of the normal ligament. Our results do not justify the use of the meniscus to replace a torn cruciate ligament.

Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign.

A comparative study of the diagnostic accuracy between the Lachman test and the anterior drawer test was performed by examining 144 knees with ruptured anterior cruciate ligaments. The diagnosis of anterior cruciate ligament rupture is often difficult to establish, especially in recent injuries with acute haemarthrosis. The diagnostic accuracy of the Lachman test in recent ruptures when the patient is examined without general anaesthetic is superior to that of the anterior drawer test, while in chronic cases with third-degree instability the two tests are equally reliable.

Meniscal injuries associated with rupture of the anterior cruciate ligament: a retrospective study.

The purpose of this study was to demonstrate the extent of meniscal involvement when the anterior cruciate ligament is torn. Data from 189 cases operated on for lesions of the anterior cruciate ligament form the basis of this report. The patients chosen for this study were all athletes forming two main groups. In one group, 82 patients were operated on immediately after their initial injury and in the other group 107 patients came for treatment because of persistent symptoms. It was recorded in the case notes whether there were any articular cartilage changes found at operation. Meniscal involvement was noted in 24.4 per cent of the patients of the first group. In particular, the meniscus was found to be torn in 20.6 per cent of the so-called 'isolated' tears and in 27.1 per cent of the combined cruciate injuries. No articular cartilage changes were noted in this group. In the second group meniscal injuries were seen in 61.6 per cent of the cases. More specifically, the menisci were involved in 26.7 per cent of the knees with first-degree instability, in 57.5 per cent with second-degree, rising to 75 per cent in knees with third-degree instability. Articular cartilage changes were seen in 20 per cent, 67.5 per cent and 78.8 per cent respectively. There is ample evidence in our study of the progressive meniscal involvement and degeneration in the knee of the athletically active individual after an anterior cruciate ligament rupture.