A prospective,randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament

Abstract

Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor results. Results after primary repair have deteriorated with time, leading to augmentation procedures that seem to have improved the results. However, there have been few prospective, randomized studies in this field. Our goal was to compare primary repair with a bone-patellar tendon-bone augmentation method and with a new method using the Kennedy Ligament Augmentation Device.

One hundred fifty patients aged 16 to 50, all of whom had acute ACL tears, were randomized with the closed envelope method to one of three groups treated with open surgical methods. Fifty patients were treated with primary repair, 50 patients with patellar tendon aug mentation, and 50 patients were augmented with the Kennedy Ligament Augmentation Device. All patients were operated on within 10 days of injury. The rehabil itation protocol was identical, consisting of a long leg cast for 2 weeks, followed by a brace with no weight bearing and limited motion for 6 weeks. The patients were followed prospectively by one surgeon (LE) using the Lysholm functional score, Tegner activity level score, clinical evaluation and KT-1000 arthrometer at 6 months, 1, and 2 years.

Three patients were lost to followup. There was no age or activity level difference between the groups. Sport activities led to 85% of the injuries, with skiing, soccer, and European handball representing 80% of injuries. All three groups reduced their activity level the 1 st year. The repair group remained at the same level after 2 years. The Ligament Augmentation Device group had a small increase, while the patellar tendon group had a significant increase to almost the preinjury level. The patellar tendon group was judged to have results superior to the other groups, according to Lach man, pivot shift, and KT-1000 test results. The Liga ment Augmentation Device group fared better than the primary repair group, according to the Lysholm score, Lachman test, and pivot shift. In general, the results were as follows: the repair group deteriorated from 1 to the 2 years control, the Ligament Augmentation Device group did not change, and the patellar tendon group improved.