Abstract
Seventy adult patients were studied during the postoperative rehabilitation period following anterior cruciate ligament reconstruction in order to investigate the role of pre-, intra-, and postoperative factors in range of motion and graft problems. A standard bone-patellar tendon-bone autograft was used for the reconstruction. Pre-and intraoperative factors such as concomitant injuries, time from injury to surgery, age, sex, and tunnel placement were recorded. Tunnel placement was recorded on intraoperative radiographs of the final guide pin placement and compared to pin placement on cadaver knees. The results indicated a significant relation between early reconstruction (<1 month) following the injury and range of motion problems during the early rehabilitation period (P<0.001). This relation disappeared by the end of the first postoperative year. Prolonged surgery was also associated with early motion problems (P<0.05). Graft laxity or failure was correlated with an earlier return of range of motion (P<0.05). We hypothesized that graft failure can have a biologic cause rather than a mechanical one since intraoperative X-rays indicated a near-anatomic tunnel placement in this patient group when compared to ideal placement in the cadaver knees.
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Almekinders LC, Freedman DM, Taft TN (1995) Parameters associated with outcome in anterior cruciate ligament reconstruction. Presented at the 62nd Ann Mtg AAOS, Orlando, Fla.
Aglietti P, Buzzi R, Zaccherotti G, Debiase P (1994) Patellar tendon versus doubled semitendinosis and gracilis tendons for anterior cruciate ligaments reconstruction. Am J Sports Med 22:211–218
Bass DO, Warren RF, Wichiewicz TL, Galinat BJ, Panariello R (1993) Arthroscopically-assisted reconstruction of the anterior cruciate ligament with the use of autogenous patellar-ligament grafts. Results after twenty four to forty two months. J Bone Joint Surg [Am] 75:1346–1355
Bylski-Austrow DI, Grood ES, Hefzy MS, Holden JP, Butler D (1990) Anterior cruciate ligament replacements: a mechanical study of femoral attachments location, flexion angle at tensioning and initial tensioning. J Orthop Res 8:522–531
Clancy WG, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar tendon, augmented by extra-articular tendon transfers. J Bone Joint Surg [Am] 64:352–359
Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks RT (1985) Instrumental measurement of anterior laxity of the knee. J Bone Joint Surg [Am] 67:720–726
Fleming BC, Beynnon BD, Johnson RJ, McLeod WD, Pope MM (1993) Isometric versus tension measurements. A comparison for reconstruction of the anterior cruciate ligament. Am J Sports Med 21:82–88
Good L, Odensten M, Gillquist J (1994) Sagittal knee stability after anterior cruciate ligament reconstruction with a patellar tendon strip. A two year follow-up study. Am J Sports Med 22: 518–523
Graf B, Uhr F (1988) Complications of intra-articular anterior cruciate ligament reconstruction. Clin Sports Med 7:835–848
Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH (1992) Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 20:499–506
Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II. The anterior cruciate ligement. Am J Sports Med 17:208–216
Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstruction and graft impingement. Clin Orthop 283:187–195
Howell SM, Clark JA, Farley TE (1991) A rationale for predicting anterior cruciate graft impingement by the intercondylar roof: a magnetic resonance imaging study. Am J Sports Med 19:276–282
Noyes FR, Mangine RE, Barber SD (1992) The early treatment of motion complications after reconstruction of the anterior cruciate ligament. Clin Orthop 277:217–288
O'Brien SJ, Warren RF, Pavlov H, Paneriello R, Wickiewicz RL (1991) Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg [Am] 73:278–286
Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15:331–341
Romano VM, Graf BK, Veene JS, Lange RH (1993) Anterior cruciate ligament reconstruction. The effect of tibial tunnel placement on range of motion. Am J Sports Med 21:415–418
Sapega AA, Moyer RA, Schneck L, Komalahiranya N (1990) Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. J Bone Joint Surg [Am] 72a:259–267
Scaglione NA, Warren RF, Wichiewicz TL, Gold DA, Panariello RA (1990) Primary repair with semitendinosis tendon augmentation of anterior cruciate ligament injuries. Am J Sports Med 18:64–73
Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthroscopy 2:138–146
Zarins B, Rowe CR (1986) Combined anterior cruciate ligament reconstruction using semitendinosis tendon and iliotibial tract. J Bone Joint Surg [Am] 68:160–177
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Almekinders, L.C., Moore, T., Freedman, D. et al. Post-operative problems following anterior cruciate ligament reconstruction. Knee Surg, Sports traumatol, Arthroscopy 3, 78–82 (1995). https://doi.org/10.1007/BF01552379
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DOI: https://doi.org/10.1007/BF01552379