This paper describes a technique for repair of the anterior cruciate ligament with protection of that repair by a synthetic augmentation device. Of 61 patients who underwent surgery 24 to 57 months (mean, 38.3) be fore data accumulation, 57 returned for followup. Sub jectively, 53 (93%) patients reported a good or excellent functional result; however, only 29 (51 %) of the patients returned to their preinjury sports level. Objectively, a radiographic Lachman test was performed on both the injured and the noninjured knee of all 57 patients. The preoperative mean difference between the knees was 8.6 mm (range, 4.6 to 17.2) and at followup it was 2.4 mm (range, -0.9 to 11.8). Radiographic abduction and adduction stress tests demonstrated stable healing of the (unrepaired) collateral ligament lesions (varus stress = 0.1 mm and valgus stress = 0.4 mm mean side-to- side difference), indicating that suturing of ruptured collateral ligaments is not necessary when the knee is centrally stabilized with the augmentation device. These results indicate that successful repair of the anterior cruciate ligament is frequently possible when enhanced with an augmentation device.
Get full access to this article
View all access options for this article.
References
1.
Aglietti P., Buzzi R., D'Andria S., et al: Patellofemoral problems after anterior cruciate ligament (ACL) reconstruction Clin Orthop, in press, 1993
2.
Andersson C. , Gillquist J.: Treatment of acute isolated and combined ruptures of the anterior cruciate ligament. A long-term follow-up study Am J Sports Med20: 7-12, 1992
3.
Andersson C. , Odensten M., Good L., et al: Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament . J Bone Joint Surg71A965-974, 1989
4.
Arnold JA, Coker TP, Heaton LM, et al. Natural history of anterior cruciate tears Am J Sports Med7305-313, 1979
5.
Bernett P., Seesko H., Feldmeier CH: Die Versorgung der frischen und der veralteten Kreuzbandruptur mit kombiniertem autologem und alloplastisch verstarktem Sehnentransplantat (Polypropylenband) . Unfallchirurgie11: 251-258,1985
6.
Burri C., Hutschenreuter P., Passler HH, et al. Functional postoperative care after reconstruction of knee ligaments. An experimental study, in Ingwerson DS (ed). The Knee Joint Amsterdam, Excerpta Medica, 1974, pp 108-112
7.
Burroughs P. , Dahners LE The effect of enforced exercise on the healing of ligament injuries Am J Sports Med18. 376-378, 1990
8.
Cerulli G., Ceccarini A., Alberti P. Neuromorphological studies on proprioceptivity of the human anterior cruciate ligament. Int J Sports Traumatol1: 49-52, 1986
9.
Dahners LE, Padgett L. The effect of joint motion on collagen-organization in healing ligaments . Trans Orthop Res Soc15: 511, 1990
10.
Dahners LE, Torke M., Gilbert J., et al. The effect of motion on collagen synthesis, DNA synthesis and fiber orientation during ligament healing Trans Orthop Res Soc14299, 1989
11.
Daniel D., Malcom L., Stone ML, et al: Quantification of knee stability and function. Contemp Orthop5(1). 83-91, 1982
12.
Dejour H. Analyse critique des resultats du traitement des laxites fraiches. Deduction therapeutique, Conclusion—Indication dans les laxites fraiches . Rev Chir Orthop69. 269-270, 1983
13.
Draganich LF , Vahay JW: An in vitro study of anterior cruciate ligament strain induced by quadriceps and hamstnngs forces J Orthop Res8: 57-63,1990
14.
Dnessen Mjm Verse Kniebandletsel Thesis. University of Amsterdam , 1989, No 90-9002650-9
15.
El Saman M. : Der Einflub von funktioneller Bewegung und Gipsruhigstellung auf die Heilung partiell durchtrennter medialer Seitenbander beim Kaninchen Thesis Experimentelle Chirurgie Uni Ulm, 1978
16.
Engebretsen L., Benum P., Fasting O., et al. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med18: 585-590, 1990
17.
Engebretsen L., Svenningsen S., Benum P.: Poor results of anterior cruciate ligament repair in adolescence Acta Orthop Scand59(6). 684-686, 1988
18.
Feagin JA, Curl WW: Isolated tear of the anterior cruciate ligament: 5-year follow-up study Am J Sports Med4. 95-100, 1976
19.
Finsterbush A., Friedman B. Early changes in immobilized rabbits knee joints A light and electron microscopic study. Clin Orthop92: 305-319, 1973
20.
Gamble JG, Edwards CC, Max SR Enzymatic adaptation in ligaments during immobilization. Am J Sports Med12: 221-228, 1984
21.
Gomez M., Woo L-Y.: The advantages of applied tension on healing medial collateral ligament . Trans Orthop Res Soc14. 184, 1989
22.
Gruber J., Wolter D., Lierse W. Der vordere Kreuzbandreflex (LCA-Reflex) Unfallchirurg89551-554, 1986
23.
Hart DP, Dahners LE Healing of the medial collateral ligament in rats J Bone Joint Surg69A1194-1199, 1987
24.
Haupt PR, Duspiva W. PDS-Augmentationsplastik bei Kreuzbandverletzungen Unfallchirurg9197-105, 1988
25.
Higgins RW, Steadman JR Anterior cruciate ligament repairs in world class skiers Am J Sports Med15. 439-447, 1987
26.
Holden DL, Eggert AW, Butler JE: The nonoperative treatment of grade I and II medial collateral ligament injuries of the knee. Am J Sports Med11. 340-344, 1983
27.
Hughston JC , in Larson RL: Presidential guest panel Am J Sports Med10: 320-326, 1982
28.
Jarvinen M. , Kannus P. Clinical and radiological long-term results after primary knee ligament surgery Arch Orthop Trauma Surg1041-6, 1985
29.
Kaplan N., Wickiewicz TL, Warren RF Primary surgical treatment of anterior cruciate ligament ruptures A long-term follow-up study Am J Sports Med18. 354-358, 1990
30.
Kennedy JC, Fowler PJ Medial and anterior instability of the knee. An anatomical and clinical study using stress machines J Bone Joint Surg53A: 1257-1270, 1971
31.
Kipfer W., Ballmer P., Gruning B., et al Late results after primary repair of anterior cruciate ligament tears. In Mueller W, Hackenbruch W (eds). Surgery and Arthroscopy of the Knee Second Congress of the European Society of Knee Surgery and Arthroscopy . Heidelberg, Sprnger-Verlag, 1988, pp 173-180
32.
Kwasny O., Schabus R., Wuppinger G., et al. Ergebnisse der Kontrollarthroskopie nach Reinsertion des vorderen Kreuzbandes und alloplastischer Verstarkung. Arthroskopie258-62, 1989
33.
Lemaire M., Combelles F., Miremad C., et al Les desinsertions meniscocapsulaires posterointernes associées aux instabilités chroniques par rupture du ligament croisé anterieur Rev Chir Orthop70: 613-622, 1984
34.
Lundberg M., Hamberg P. Early mobilization of isolated partial ruptures of the medial collateral ligament. A randomized comparison of bracing vs elastic wrapping In Mueller W, Hackenbruch W (eds). Surgery and Arthroscopy of the Knee Second Congress of the European Society of Knee Surgery and Arthroscopy Heidelberg, Spinger-Verlag, 1988 , pp 112-115
35.
Lysholm M., Giliquist J. Effect of different knee rehabilitation exercises on tibial translation Clin Biomechan, in press, 1992
36.
Lysholm J., Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med10150-154, 1982
37.
Meunier C., Moinet Ph, Mallet F: Reparation des lesions récentes du ligament croisé anterieur. Sport et Medic act3. 21-24, 1988
38.
More RC, Daniel DM, Harris S.: Quadriceps rehabilitation after ACL reconstruction A comparison of two types of exercise Trans Orthop Res Soc16604, 1991
39.
Muller W. Das Knie. Form, Funktion und ligamentare Wiederherstellungschirurgie . Heidelberg, Springer-Verlag, 1982
40.
Noack W., Scharf HP: Aktueller Stand in der Therapie der vorderen Kreuzbandverletzungen Sport-verl Sportsch1 . 13-19, 1987
41.
Noyes FR Functional properties of knee ligaments and alterations induced by immobilization A correlative biomechanical and histological study in primates . Clin Orthop123. 210-242, 1977
42.
Ohkoshi Y., Yasuda K. Biomechanical analysis of shear force exerted on anterior cruciate ligament during half squat exercise Trans Orthop Res Soc14192, 1989
43.
Paar O. Verstarkung der frisch geklebten oder genahten Ruptur des vorderen Kreuzbandes durch die Semitendinosussehne—indikation und Fruhergebnisse Chirurg56728-734, 1985
44.
Palmer J. Injunes to the cruciate ligaments of the knee joint as a surgical problem Reconstr Surg Traumatol4. 181-196, 1957
45.
Passler HH, Henkemeyer H., Burri C. Funktionelle Behandlung nach Bandnaht und -plastik am Kniegelenk. Langenbecks Arch Chir Suppl89. 51-53, 1972
46.
Paessler HH , Lanzetta A., Rettagliata F. The radiological Lachman test. Int J Sports Traumatology2. 85-95, 1987
47.
Paessler HH , Maerz S. Der radiologische Lachman-Test. Eine einfache und sichere Methode zum Nachweis von Kreuzbandschaden Unfallchirurgie12: 295-300, 1986
48.
Pitman M., Nainzadeh N., Menche D., et al Intraoperative evaluation of the neurosensory function of the anterior cruciate ligament in humans utilizing somato-sensory evoked potentials . Arthroscopy, in press, 1993
49.
Reyher C. Uber die Veranderungen der Gelenke bej dauernder Ruhe Dtsch Z Chir3189-200, 1974
50.
Robson Awm. Ruptured cruciate ligaments and their repair by operation. Ann Surg715-176, 1903
51.
Schabus R. Die Bedeutung der Augmentation fur die Rekonstruktion des vorderen Kreuzbandes Acta Chir Austrica Suppl76. 1-48, 1988
52.
Schultz RA, Miller DC, Kerr CS Mechanoreceptors in human cruciate ligaments A histological study. J Bone Joint Surg66A. 1072-1076, 1984
53.
Segond P.: Recherches cliniques et expérimentales sur les épanchements sangouins du genou par entorse Prog Med7. 297-299, 319-321, 340-341, 379-381, 400-401, 419-421, 1879
54.
Seiler H., Kayser M., Niemeyer H., et al. Isolated tears of medial collateral ligament of the knee—operative or conservative treatment? In Mueller W, Hackenbruch W (eds): Surgery and Arthroscopy of the Knee. Second Congress of the European Society of Knee Surgery and Arthroscopy Heidelberg, Springer-Verlag, 1988, p 111
55.
Sgaglione NA , Warren RF, Wickiewicz TL, et al: Primary repair with semitendinosus tendon augmentation of acute anterior cruciate ligament injuries Am J Sports Med18: 64-73, 1990
56.
Shelbourne KD, Whitaker HJ, McCarroll JR, et al. Anterior cruciate ligament injury Evaluation of intraarticular reconstruction of acute tears without repair. Two to seven year followup of 155 athletes. Am J Sports Med18. 484-489, 1990
57.
Shields C., Stevenson D. Acute anterior cruciate ligament tear. Primary repair with and without patellar tendon augmentation Am J Sports Med17. 711 , 1989
58.
Solomonow M. , Baratta R., Zhou BH, et al The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability Am J Sports Med15207-213, 1987
59.
Staubli H-U. , Jakob RP Anterior knee motion analysis Measurement and simultaneous radiography. Am J Sports Med19. 172-177, 1991
60.
Stanitzki CL Rehabilitation following knee injury Clin Sports Med4495-511,1985
Strobel M., Stedtfeld HW Diagnostic Evaluation of the Knee. Berlin, Springer Verlag, 1990
63.
Tegner Y., Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop198. 43-49, 1985
64.
Tiling TH, Schmid A., Edelmann M., et al Therapie der ligamentaren vorderen Kreuzbandruptur—Nachuntersuchungsergebnisse in Abhangigkeit von der RiBlokalisation und Versorgung Hefte zur Unfallheilkunde1891089-1105,1987
Woo Sl-Y , Gomez MA, Sites TJ, et al. The biomechanical and morphological changes in the medial collateral ligament of the rabbit after immobilization and remobilization J Bone Joint Surg69A. 1200-1211, 1987
Yasuda K., Sasaki T. Muscle exercise after anterior cruciate ligament reconstruction. Clin Orthop220. 266-274, 1987
69.
Yasuda K., Sasaki T.: Exercise after anterior cruciate ligament reconstruction The force exerted on the tibia by the separate isometric contractions of the quadriceps or the hamstrings Clin Orthop220. 275-282, 1987
70.
Zimny ML, Schutte M., Dabezies E.: Mechanoreceptors in the human anterior cruciate ligament Anat Rec214204-209, 1986
