RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT IN PATIENTS WHO ARE AT LEAST 40 YEARS OLD - A LONG-TERM FOLLOW-UP AND OUTCOME STUDY

The long-term results were reviewed for seventy-two patients (seventy- five knees) who had had a bone-patellar ligament-bone intra-articular reconstruction of the anterior cruciate ligament between August 1984 a nd May 1992., The mean age of the patients at the time of the operatio n was forty-five years (range, forty to sixty years), Three patients h ad a bilateral procedure, The primary mechanisms of injury were accide nts that occurred during skiing (thirty-two knees), tennis (fourteen k nees), and soccer (five knees), We analyzed the responses to subjectiv e questionnaires, the functional results, and the objective clinical d ata, The clinical examination included assessment of the range of moti on, performance of Lachman and pivot-shift tests, and measurements wit h use of a KT-1000 arthrometer. All knees were evaluated with use of t hree common rating scales: that of Lysholm and Gillquist; that of The Hospital for Special Surgery as modified by Insall et al.; and the Int ernational Knee Ligament Standard Evaluation Form, At the latest follo w-up evaluation, at a mean of fifty-five months (range, twenty-six to 117 months), three patients reported pain or swelling, No patient repo rted giving-way or symptoms related to the patellofemoral joint, The m ean range of extension was -12 to 6 degrees, compared with -8 to 42 de grees preoperatively; and the mean range of flexion was 112 to 150 deg rees, compared with 52 to 154 degrees preoperatively, Flexion was limi ted to 112 degrees in one patient, but this was 5 degrees greater than that of the uninvolved knee, Sixty knees (80 per cent) had a negative pivot-shift test, and ten knees (13 per cent) had a grade of 1+., On testing with the KT-1000 device at maximum manual pressure, the mean d ifference between the injured and uninjured knees was found to have im proved by 5.1 millimeters, from 6.4 millimeters preoperatively to 1.4 millimeters postoperatively (p < 0.01), The grade on the International Knee Ligament Standard Evaluation Form improved markedly; seventy-two knees (96 per cent) had a grade of C or D preoperatively, whereas sev enty knees (93 per cent) had a grade of A or B postoperatively The Hos pital for Special Surgery score improved from a mean of 69 points preo peratively to a mean of 92 points postoperatively (p < 0.01), The mean score according to the scale of Lysholm and Gillquist increased from a mean of 63 points preoperatively to a mean of 93 points postoperativ ely (p < 0.01), All patients indicated that they were pleased with the result of the procedure, Bicycling was resumed at a mean of four mont hs; jogging, at a mean of nine months; skiing, at a mean of ten months ; and tennis, at a mean of twelve months.