Failure of clinical methods in assessing graft integrity after anterior cruciate ligament reconstruction: An arthroscopic evaluation

We reviewed the findings of 24 patients who underwent knee arthroscopy foll owing a bone-patellar tendon-bone autograft anterior cruciate ligament (ACL ) reconstruction. Preoperative symptoms included pain, swelling, catching, and/or locking, Only one patient presented with subjective instability. The subjective and objective clinical findings as well as KT-1000 examination were compared with the arthroscopic findings. Thirteen of the 24 patients h ad an insufficient ACL graft by arthroscopic examination. In only 5 of thes e patients did the physical examination and/or KT-1000 results reliably det ect an insufficient ACL graft. The remaining 8 patients had a stable knee b y subjective and objective clinical criteria as well as strict KT-1000 crit eria. No significant degenerative changes or lack of motion was present in this group. Also, 7 of the 8 patients had an excellent or good Orthopadisch e Arbeitsgruppe Knie (OAK) score and maintained a high level of function. I n the two patients who underwent preoperative magnetic resonance imaging th e lack of an intact graft was confirmed. A subset of patients appear to hav e stable knees despite the lack of a functioning ACL graft. Therefore, stan dard clinical and KT-1000 criteria for ACL deficient knees have limitations in detecting graft integrity after ACL reconstruction. Arthroscopy or magn etic resonance imaging may be needed when graft integrity is in question.