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Replacement of the anterior cruciate ligament

A comparative study of four different methods of reconstruction

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Summary

Eighty-seven patients have been examined 2 years on average after knee ligament reconstruction for a torn anterior cruciate ligament. The patients were divided into four groups according to the type of operation that had been carried out. In the first group an extra-articular lateral repair (“MacIntosh tenodesis”) had been performed, in the second group an intra-articular “over-the-top” repair using the quadriceps and the patellar tendon, in the third group a modified “Eriksson” procedure using the patellar tendon, and in the fourth group a combined intra- and extra-articular repair using carbon fibres as a graft. The results of the operations in the different groups are compared. The best results were obtained with the “Eriksson” procedure, closely followed by the “over-the-top” repair. Limited range of motion and retropatellar pain resulting from changes in the alignment of the patella were the main problems. The results after the use of carbon fibres were less good. In two cases the graft tore without further trauma, and there were also problems because of restricted range of motion and retropatellar pain. The worst results were found after extra-articular lateral repair, due to insufficient stability in many cases. However, the best results with regard to the range of motion were found in this group.

Zusammenfassung

Es wurden 87 Patienten im Durchschnitt 2 Jahre nach Ersatzplastik bei zerrissenem vorderem Kreuzband und chronischer Instabilität nachkontrolliert. Die Patienten wurden in vier Gruppen eingeteilt. In jeder Gruppe war eine andere Art von Ersatzplastik durchgeführt worden. In der ersten Gruppe war es ein extraartikulärer “lateral repair” (sog. “MacIntosh-Plastik”), in der zweiten Gruppe eine intraartikuläre “over the top” geführte Plastik mit der Quadriceps- und der Patellarsehne, in der dritten eine modifizierte “Eriksson”-Plastik unter Verwendung der Patellarsehne und in der vierten Gruppe eine kombinierte intra- und extraartikuläre Plastik mit “Carbon fibres”. Die Resultate der Operationen in allen vier Gruppen werden miteinander verglichen. Die besten Ergebnisse zeigte das Vorgehen nach “Eriksson”, dicht gefolgt vom “over the top-repair”. Probleme, die in diesen zwei Gruppen auftraten, betrafen eingeschränkte Kniebeweglichkeit und retropatelläre Schmerzen wegen veränderter Führung der Patella. Die Resultate in der Gruppe mit Verwendung der “carbon fibres” waren weniger gut. In zwei Fällen ist das Transplantat ohne Trauma gerissen, zudem traten auch hier Beschwerden auf wegen eingeschränkter Beweglichkeit und retropatellärer Schmerzen. Am wenigsten gut waren die Resultate nach extraartikulärem “lateral repair”. In vielen Fällen konnte durch these Methode keine genügende Stabilität erreicht werden. Andererseits war die Beweglichkeit des Kniegelenkes nach dieser Operation kaum je eingeschränkt.

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Authors and Affiliations

  1. Division of Orthopaedics, Dept. of Surgery, University of Basle, Felix-Platter-Spital, CH-4055, Basle, Switzerland

    F. Hefti, A. Gächter, H. Jenny & E. Morscher

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  1. F. Hefti
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  2. A. Gächter
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  3. H. Jenny
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  4. E. Morscher
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Hefti, F., Gächter, A., Jenny, H. et al. Replacement of the anterior cruciate ligament. Arch. Orth. Traum. Surg. 100, 83–94 (1982). https://doi.org/10.1007/BF00462344

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