RECONSTRUCTION OF THE ANTERIOR AND POSTERIOR CRUCIATE LIGAMENTS AFTERKNEE DISLOCATION - USE OF EARLY PROTECTED POSTOPERATIVE MOTION TO DECREASE ARTHROFIBROSIS
Fr. Noyes et Sd. Barberwestin, RECONSTRUCTION OF THE ANTERIOR AND POSTERIOR CRUCIATE LIGAMENTS AFTERKNEE DISLOCATION - USE OF EARLY PROTECTED POSTOPERATIVE MOTION TO DECREASE ARTHROFIBROSIS, American journal of sports medicine, 25(6), 1997, pp. 769-778
We report a critical rating of results for 11 patients with bicruciate
ligament reconstructions and immediate protected knee motion after kn
ee dislocations (seven acute and four chronic). Six patients had concu
rrent repair or reconstruction of medial ligamentous structures, and s
ix had reconstruction of the lateral and posterolateral ligaments. All
patients returned for followup at a mean of 4.8 years postoperatively
, Follow-up arthrometric testing at 20 degrees of flexion showed 10 kn
ees had less than 3 mm of increased total anterior-posterior displacem
ent and 1 knee had 7 mm of increase. At 70 degrees of flexion, 9 knees
had less than 3 mm of increased displacement and 2 knees had more tha
n 6 mm of increase, The failure rates were as follows: 18% of posterio
r cruciate ligament reconstructions (2 of 11), 9% of anterior cruciate
ligament reconstructions (1 of 11), 17% of lateral and posterolateral
procedures, and 0% of medial collateral ligament procedures, At follo
wup, five of the seven patients with acute injuries had no limitations
with daily or sports activities. Three of the four patients with chro
nic ruptures were asymptomatic with daily activities, but only one was
asymptomatic with light sports. Five patients (all acute injuries) re
quired treatment for knee motion limitations. Nine patients had full r
ange of motion at followup. We concluded that simultaneous bicruciate
ligament reconstructions, performed with associated medial or lateral
procedures, are warranted to restore function to all ligament structur
es, Even though immediate motion was used, several patients required e
arly manipulation or arthroscopic debridement, which restored full mot
ion and prevented permanent arthrofibrosis.