Retrospective direct comparison of three intraarticular anterior cruciate ligament reconstructions

Abstract

A long-term retrospective study (minimum 5 years) was done looking at three groups of anterior cruciate defi cient knee patients using both subjective and objective anterior cruciate tests. Twenty-seven chronic anterior cruciate ligament deficient knees reconstructed with the middle third of the patellar tendon and 28 chronic anterior cruciate ligament deficient knees reconstructed with the semitendinosus tendon were included in this consecutive group of patients and were felt to be directly comparable. It was found that the chronic an terior cruciate ligament deficient group reconstructed with the semitendinosus tendon had 4 excellent, 10 good, 7 poor, and 7 failures with an objective score averaging 4.5 of a possible 12, while the comparable group reconstructed with the middle third of the patellar tendon had 16 excellent, 7 good, 3 poor, and only 1 failure with a score of 10 of a possible 12 (P < 0.0032). For completeness sake, 20 anterior cruciate deficient knees from this group of consecutive patients that were reconstructed acutely with the semitendinosus tendon were also examined. This group had 8 excellent results, 9 good, 3 poor, and no failures with a score of 9.8 (P < 0.03 compared to the other group using the semiten dinosus tendon). This comparison between the two groups where the semitendinosus tendon was used in the anterior cruciate ligament reconstruction was made only to show the difference between studies dealing with knee reconstructions. There may be a significant difference between a study dealing with acutely recon structed knees versus one focusing on chronically re constructed knees, most likely because of both patient selection and time between injury and reconstruction. Subjectively, the activity forms gave postreconstruc tion activities of 112 of 200 for the chronically recon structed group using semitendinosus tendon, 115 for the chronically reconstructed group using the middle third of the patellar tendon, and 150 in the acutely reconstructed group using the semitendinosus tendon. The subjects rated their knee 6.2 (chronically recon structed with semitendinosus), 6.4 (chronically recon structed with middle third patellar tendon), and 7.9 (acutely reconstructed with semitendinosus) on a scale of 0 to 10. This paper will point out the superiority of using the middle third of the patellar tendon over the use of the semitendinosus tendon in chronically unstable knees. The semitendinosus tendon should not be used even with extraarticular augmentations. The data for the semitendinosus tendon in acute anterior cruciate liga ment reconstruction is included to show how different two groups of patients can be based on the time of reconstruction from the date of injury.