OVER-THE-TOP OR TUNNEL RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT - A PROSPECTIVE RANDOMIZED STUDY OF 54 PATIENTS

We report a review of 54 patients with chronic anterior cruciate ligam ent rupture treated by patellar-quadriceps tendon graft augmented with polypropylene braid (Kennedy-LAD). The femoral placement of the graft was randomised to either a modified over-the-top (OTT) or a tunnel po sition obtained by an isometric drill guide (ISO). At the two-year fol low-up both procedures had resulted in improvement of subjective knee function and activity level. Stereoradiographic measurements showed re duction of anteroposterior laxity to near normal in about one-third of the patients, but muscle strength and objective functional performanc e showed little or no changes. The OTT group had better subjective kne e function. We were unable to confirm the theoretical advantages of th e use of the drill guide, partly because it provided a tibial tunnel w hich was too anterior.