68 patients who had had reconstruction of an acute rupture of the anterior cruciate ligament with either a fascia lata or a bone-patellar ligament-bone allograft returned for 2 follow-up evaluations, at 2 to 4 years and at 5 to 9 years (mean, 7 years) postoperatively. The early (2 to 4-year) results in these patients have been reported previously. The mean time between the early and the later evaluation was 56 months (range, 20 to 96 months). At the early evaluation, 52 (78 per cent) of the 67 patients who were tested with an arthrometer at 89 newtons had less than 3 millimeters of increased anterior-posterior displacement compared with that of the contralateral limb; at the later evaluation, 54 (79 per cent) of the 68 patients had this finding (p=0/97). With use of arthrometric and pivot-shift-test data, 48 (75 per cent) of 64 grafts were classified as functional at the early evaluation and 14 (22 per cent), as partially functional; 2 (3 per cent) had failed. (4 grafts could not be classified because of incomplete data.) At the later examination, 50 (74 per cent) of the 68 grafts were functional, 13 (19 per cent) were partially functional, and 5 (7 per cent) had failed. At the early evaluation, 62 (93 percent) of 67 patients had no palpable patellofemoral crepitus and 5 (7 per cent) had moderate crepitus. At the later evaluation, 51 (75 per cent) of the 68 patients continued to have no crepitus, 16 (24 per cent) had moderate crepitus, and on (1 per cent) had severe crepitus. An increase in crepitus between the early and the later evaluation was found in 12 (19 per cent) of the 62 patients who had normal crepitus at the early evaluation. With the numbers available, no factor, such as the type of graft, associated ligamentous injury, or meniscal repair, correlated significantly with the amount of patellofemoral crepitus at either follow-up evaluation. At the early evaluation, the result was rated excellent or good for 38 (60 per cent) of 63 patients, fair for 21 (33 per cent), and poor for 4 (6 per cent). (The result could not be rated for 4 patients because of incomplete data.) At the later evaluation, the result was rated excellent or good for 45 (66 per cent) of the 68 patients, fair for 18 (26 per cent), and poor for 5 (7 per cent). For 9 patients (13 per cent), the over-all rating deteriorated from excellent or good at the early evaluation to fair or poor at the later examination. For 6 patients (9 per cent), the rating improved from fair at the early evaluation to excellent or good at the later evaluation. With the numbers available, we could detect no significant decrease in anterior-posterior displacement of the knee, patellofemoral crepitus, the pain or the jumping score, or the over-all knee rating over the time-period studied. While we currently recommend arthroscopically assisted reconstruction with a bone-patellar ligament-bone autogenous graft as the first choice for an acute rupture of the anterior cruciate ligament, our study shows that favorable results can be obtained with allografts and justifies their use when the surgeon and patient choose this approach.
Copyright remains with the authors and publisher.
68 patients who had had reconstruction of an acute rupture of the anterior cruciate ligament with either a fascia lata or a bone-patellar ligament-bone allograft returned for 2 follow-up evaluations, at 2 to 4 years and at 5 to 9 years (mean, 7 years) postoperatively. The early (2 to 4-year) results in these patients have been reported previously. The mean time between the early and the later evaluation was 56 months (range, 20 to 96 months). At the early evaluation, 52 (78 per cent) of the 67 patients who were tested with an arthrometer at 89 newtons had less than 3 millimeters of increased anterior-posterior displacement compared with that of the contralateral limb; at the later evaluation, 54 (79 per cent) of the 68 patients had this finding (p=0/97). With use of arthrometric and pivot-shift-test data, 48 (75 per cent) of 64 grafts were classified as functional at the early evaluation and 14 (22 per cent), as partially functional; 2 (3 per cent) had failed. (4 grafts could not be classified because of incomplete data.) At the later examination, 50 (74 per cent) of the 68 grafts were functional, 13 (19 per cent) were partially functional, and 5 (7 per cent) had failed. At the early evaluation, 62 (93 percent) of 67 patients had no palpable patellofemoral crepitus and 5 (7 per cent) had moderate crepitus. At the later evaluation, 51 (75 per cent) of the 68 patients continued to have no crepitus, 16 (24 per cent) had moderate crepitus, and on (1 per cent) had severe crepitus. An increase in crepitus between the early and the later evaluation was found in 12 (19 per cent) of the 62 patients who had normal crepitus at the early evaluation. With the numbers available, no factor, such as the type of graft, associated ligamentous injury, or meniscal repair, correlated significantly with the amount of patellofemoral crepitus at either follow-up evaluation. At the early evaluation, the result was rated excellent or good for 38 (60 per cent) of 63 patients, fair for 21 (33 per cent), and poor for 4 (6 per cent). (The result could not be rated for 4 patients because of incomplete data.) At the later evaluation, the result was rated excellent or good for 45 (66 per cent) of the 68 patients, fair for 18 (26 per cent), and poor for 5 (7 per cent). For 9 patients (13 per cent), the over-all rating deteriorated from excellent or good at the early evaluation to fair or poor at the later examination. For 6 patients (9 per cent), the rating improved from fair at the early evaluation to excellent or good at the later evaluation. With the numbers available, we could detect no significant decrease in anterior-posterior displacement of the knee, patellofemoral crepitus, the pain or the jumping score, or the over-all knee rating over the time-period studied. While we currently recommend arthroscopically assisted reconstruction with a bone-patellar ligament-bone autogenous graft as the first choice for an acute rupture of the anterior cruciate ligament, our study shows that favorable results can be obtained with allografts and justifies their use when the surgeon and patient choose this approach.
Copyright remains with the authors and publisher.