Retrospective comparison of four intra-articular anterior cruciate ligament reconstructions using three evaluation systems

Abstract

In a retrospective study, 57 patients were examined following an intra-articular cruciate ligament reconstruction. The patients were divided into four groups according to the type of repair and the lapse of time between injury and operation. Twenty-five patients had undergone reconstruction with a semitendinosus tendon after acute instability (AS'T) and six, after chronic instability (CST). Eleven patients had received an acute reconstruction using the middle third of the patellar tendon (APT), as had 15 with chronic instability (CPT). The mean follow-up time was 48 months for the AST group, 60 months for the CST, 33 months for the APT, and 36 months for the CPT. In order to compare the groups, we used the Lysholm and OAK scores and the IKDC evaluation system. The only statistically significant difference found involved the IKDC evaluation system between the AST and CST groups. No significant decrease in activity level was noted in any of the groups. With the exception of the CST group, the preoperative Lachman test disappeared significantly at follow-up in all groups. The side-to-side difference of anterior tibial displacement measured with the KT 2000 at 25° knee flexion and a load of 89 newtons was 1.32 mm for the APT group, 2.44 mm for the AST group, 2.47 mm for the CPT group, and 3.33 mm for the CST group. This side-to-side difference was not significant in the APT group. In the CPT group, arthrofibrosis was found in 27% of the patients, which led to reoperation. Reconstruction of the anterior cruciate ligament using the semitendinosus is no longer indicated for chronic instability. ACL-plasty with the middle third of the patellar tendon restored practically normal stability in acute ACL insufficiency.