Long-term results of tendon allografts for anterior cruciate ligament replacement in revision surgery and in cases of combined complex injuries.

We assessed the long-term validity of anterior cruciate ligament (ACL) reconstruction using tendon allografts. Nineteen patients were followed up for 8 years (mean 94 months) after tendon allograft replacement for ACL rupture. The evaluation used the International Knee Documentation Committee (IKDC) grades, the Lysholm score, and the Tegner scale. Two patients sustained a rerupture after a serious injury. Two others scored poorly because of associated proximal ipsilateral tibial and other fractures (IKDC grade D). Nine patients scored nearly normal (grade B) and six abnormal (grade C). The Lysholm score showed nine excellent (average 98), five good (average 87), and one fair result (70). Two of the excellent-rated patients were IKDC grade C solely because the X-rays showed a slight (1-mm) narrowing of the medial cartilage. One patient had 0.5-mm narrowing. The X-ray findings may indeed indicate future problems. On the Tegner scale the sports level decreased by an average of 2.1 points (from 6.87 to 4.73), and by 0.8 point compared to the level at which the patient had wished to perform. ACL repair using tendon allografts appears to provide satisfactory results on the Lysholm and Tegner scales. The IKDC scoring suggests future cartilage degeneration. Its value for knees with multiple ligament lesions and for revision cases is demonstrated. Only two reruptures were noted, suggesting good reliability of allografts on the long term.

Prosthetic versus tendon allograft replacement of ACL-deficient knees.

ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconstructions were performed using a Dacron graft. Evaluation was done using the Lysholm rating system and Tegner scale. The Lysholm score averaged 84.2. Regarding the level of performance, the patients had lost an average of 2.1 points on the Tegner scale. 18 of the 57 patients developed a synovitis. In 11 patients (19 per cent) the implant had to be removed. CT scan of the operated knee proved the Dacron graft to be nonfunctioning in as many as 40 per cent of the patients. Because of this high complication rate, the authors started to use deep-frozen (-70 degrees C) tendon allograft material. Both Achilles and Tibialis Posterior tendons were implanted using the over-the-top technique with or without an additional extra-articular procedure. Complications as seen with the rigid synthetic ligaments were absent. The preliminary results seem satisfactory in that the functional demands placed on the knee are not restricted.