Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis

Abstract

Forty-four patients with symptomatic chronic anterior cruciate ligament instabilities that had been recon structed with the central one-third patellar tendon and a lateral extraarticular iliotibial band tenodesis were studied at an average followup of 7 years (range, 4 to 10). The cases with associated medial, lateral, or pos terior laxity were not included, nor were the cases with more than minimal preoperative degenerative changes. The average age at surgery was 21 years (range, 16 to 33). A postoperative cast was used for 4 weeks. Satisfactory objective stability, which was defined as a KT-1000 side-to-side difference of up to 5 mm at the manual maximum test, was obtained in 37 (84%) of the patients. In 25 patients (57%), stability was restored within normal limits (≤3 mm). No deterioration of the KT-1000 stability was noted at two follow-up visits performed by the same examiner (at an average of 4 and 7 years). A return to high-risk sports was possible in 27 (62%) of the patients. Difficulties in regaining a complete range of motion were recorded in 5 (11 %) of the patients. A flexion contracture of 5° to 7° was also found in 5 patients. Significant patellofemoral symptoms were present in 4 patients (9%). A 5% to 11% shortening of the patella tendon was observed in 14 (32%) of the knees, but did not correlate with patellar problems. Moderate radio graphic changes were noted in eight patients (18%) at followup and correlated with meniscectomy and pain. Overall satisfactory results were obtained in this initial experience in 29 (66%) of the patients. We believe that the operation gives reliable stability in the majority of the cases, but the results may be improved with more attention to isometry, earlier postoperative mobilization with complete extension, and a faster rehabilitation course.