Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability

We performed combined internal and external anterior cruciate ligament (ACL ) reconstruction with the iliotibial band autograft in 169 consecutive pati ents with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer followup a fter 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again; nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reco nstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side -to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptu res, this results in a "stability" failure rate of 8.8%. The overall IKCD r ating showed normal knee function in 88 (73%) and nearly normal knee functi on in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores a nd Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. T he combined internal and external iliotibial band procedure can restore kne e stability and function in the majority of chronic ACL-insufficient knees.