Fr. Noyes et al., USE OF ALLOGRAFTS AFTER FAILED TREATMENT OF RUPTURE OF THE ANTERIOR CRUCIATE LIGAMENT, Journal of bone and joint surgery. American volume, 76A(7), 1994, pp. 1019-1031
A prospective study was done of the use of allogeneic tissue to recons
truct the anterior cruciate ligament in knees in which an intra-articu
lar or an extra-articular operation had failed. Sixty-six consecutive
patients (sixty-six knees) had such an operation with use of bone-pate
llar ligament-bone allografts; all but one returned for follow-up eval
uation twenty-three to seventy-eight months (mean, forty-two months) a
fter the operation. A total of 235 previous operations had been perfor
med in these sixty-six knees, including eighty-one procedures for rupt
ure of the anterior cruciate ligament. The results of the allograft pr
ocedure were evaluated with a subjective and objective system that rat
ed twenty factors. The anterior-posterior displacement was substantial
ly improved in most of the patients. According to data derived from ar
thrometric studies and pivot-shift tests of the fifty-seven patients w
ho were so evaluated and in whom the condition was unilateral, 53 per
cent (thirty) of the reconstructed ligaments were determined to be fun
ctional; 21 per cent (twelve ligaments), partially functional; and 26
per cent (fifteen ligaments), a failure. When we calculated the rate o
f failure by including ten failures that had occurred within two years
after the operation with the fifteen that occurred in patients who ha
d been followed for at least two years, the over-all rate of failure w
as 33 per cent (twenty-five of seventy-five operations). There was sig
nificant improvement in the subjective ratings of functional limitatio
ns and symptoms (p < 0.01) and in the over-all rating score (p < 0.000
1). However, there was a significant difference between the scores of
the patients in whom the surfaces of the articular cartilage had appea
red normal at the index operation and those of the patients in whom th
ere had been noteworthy fissuring and fragmentation or exposure of sub
chondral bone. After the program of rehabilitation, which included imm
ediate motion of the knee, a range of motion of 0 to 135 degrees was r
estored in all but five knees, four of which lacked only 5 degrees of
this extent of flexion or extension. The results demonstrate that bone
-patellar ligament-bone allografts may be used when proper autogenous
tissues are not available and that symptoms and abnormal displacement
were reduced in most of our patients.