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Reconstruction of chronic anterior cruciate ligament insufficiency in athletes using a bone-patellar tendon-bone autograft

A two-year follow up study

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Summary

Thirty athletes (18 men and 12 women) were followed up for an average of 2.2 years after operative reconstruction for chronic anterior cruciate injuries with a mini-arthrotomy technique using a bone-patellar ligament-bone autograft. All the patients were active in sports, and the injuries in 40% occurred while playing soccer. The average delay between injury and reconstruction was 4.7 years; before this 26 knee operations had been carried out in 22 of the patients. At follow up, 20 patients were satisfied subjectively and 22 were classified objectively as excellent or good. Anteroposterior stability was good in 29 knees, and the Lachman and pivot shift tests were strongly positive in only one patient. Wasting of the thigh was more prominent in 9 patients who had a flexion deficit of 10° or more, than in the other 21. Of the 15 competitive athletes, who had all given up their sport after injury, 8 were able to return to sport. Reconstruction using a bone-patellar ligament-bone autograft is recommended for symptomatic chronic anterior cruciate ligament insufficiency in athletes.

Résumé

Trente athlètes (18 hommes et 12 femmes) ayant bénéficié d'une reconstruction pour insuffisance chronique du ligament croisé antérieur par une technique utilisant une miniarthrotomie et une autogreffe os-tendon rotulien-os ont été revus avec un recul moyen de 2,2 ans (de 1 à 4 ans). Tous les patients de cette étude étaient des sportifs, 15 d'entre eux étaient des compétiteurs et les 15 autres des sportifs de loisir. L'accident initial était survenu en pratiquant le football dans 12 cas (40%) et le baseball finlandais dans 3 cas (10%). Le délai entre l'accident et la reconstruction était en moyenne de 4,7 ans (de 0,5 à 20 ans). Avant la reconstruction 22 patients avaient eu 26 interventions. Lors de la révision 20 patients (73%) étaient satisfaits subjectivement de leurs résultats et d'après nos critères objectifs, 22 patients (73%) étaient cotés excellents ou bons. D'après la cotation de Lysholm, 16 patients (53%) étaient excellents ou bons. La stabilité antéropostérieure était bonne dans 29 genoux (90%), quant au test de Lachman et au “pivot-shift”, ils étaient fortement positifs (3+) chez un patient seulement. L'atrophie des muscles de la cuisse était plus marquée chez les 9 patients présentant un déficit de flexion de 10° ou plus (moyenne 1,6 cm) que chez les 21 autres (moyenne 0,7 cm) (p<0.05). Parmi les 15 compétiteurs qui avaient tous abandonné le sport après l'accident initial, 8 ont pu reprendre leur activité sportive après la reconstruction. En conclusion, la reconstruction du LCA par une autogreffe os-tendon rotulien-os peut être recommandée dans les insuffisances chroniques symptomatiques chez les athlètes.

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Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, University Hospital, PO Box 2000, SF-33521, Tampere, Finland

    M. Järvinen, A. Natri & M. Lehto

  2. Research Station of Sports Medicine and Accident and Trauma Research Centre, the UKK Institute, SF-33521, Tampere, Finland

    A. Natri & P. Kannus

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  1. M. Järvinen
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  2. A. Natri
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  3. M. Lehto
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  4. P. Kannus
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Järvinen, M., Natri, A., Lehto, M. et al. Reconstruction of chronic anterior cruciate ligament insufficiency in athletes using a bone-patellar tendon-bone autograft. International Orthopaedics 19, 1–6 (1995). https://doi.org/10.1007/BF00184906

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