ARTHROSCOPICALLY ASSISTED RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT WITH USE OF AUTOGENOUS PATELLAR-LIGAMENT GRAFTS - RESULTS AFTER 24 TO 42 MONTHS

The results for the first sixty-nine consecutive patients who had had seventy arthroscopically assisted reconstructions of the anterior cruc iate ligament with use of an autogenous patellar-ligament graft at our institution were reviewed retrospectively. Sixty-seven patients (sixt y-eight knees) were available for evaluation after a minimum of two ye ars. All patients had been managed with early, postoperative range-of- motion exercises and-a standardized program of physical therapy. At th e time of the most recent follow-up evaluation, the median ligament sc ore, according to the rating system of The Hospital for Special Surger y, was 93 of a possible 100 points. Of the sixty-eight knees, forty-fo ur were rated excellent; fifteen, good; six, fair; and three, poor. Ei ghteen knees had symptoms related to the patellofemoral joint and sixt y-three had a full range of motion; two knees had had manipulation for loss of flexion. At the follow-up evaluation, KT-1000 arthrometric me asurements were obtained for both knees of fifty-six patients. Eighty- four per cent of the patients had an increase of three millimeters or less in anterior-posterior displacement of the tibia on the reconstruc ted side compared with the normal side, while 93 per cent had an incre ase of four millimeters or less. Postoperatively, there was no apparen t association between changes in the Insall-Salvati patellar ligament- to-patella ratios and pain in the patellofemoral joint. The results of the arthroscopically assisted reconstructions combined with use of ea rly range-of-motion exercises were comparable with those reported afte r open reconstruction and immobilization of the limb in a plaster cast . The frequency of pain in the patellofemoral joint and the need for m anipulation because of loss of motion were decreased after the arthros copically assisted procedures.