The Journal of Bone and Joint Surgery, Vol 64, Issue 3 352-359, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers

WG Clancy, DA Nelson, B Reider and RG Narechania

Eighty patients with persistent clinical and functional instability of the knee due to anterior cruciate ligament insufficiency underwent the operation reported, in which one-third of the patellar ligament substitutes for the cruciate ligament and extraarticular tendon transfers, medial and lateral, augment the substitution. The patients were followed for a minimum of two years, and fifty returned for personal evaluation. The average follow-up was thirty-three months, with a range of two to five years. There were thirty-five male and fifteen female patients. The average age was twenty-three years. The average interval from initial injury to the index operation was two years. Meniscal tears and articular changes were noted in most of the patients. Forty-three (86 per cent) of the fifty patients had at least one torn meniscus, twenty-seven patients (54 per cent) had significant degenerative articular changes, and fourteen (28 per cent) had patellar articular changes. In the procedure described, eccentric placement of the tibial and femoral tunnels for more accurate placement of the patellar ligament substitute is essential. The over-all results were graded as excellent in thirty knees, good in seventeen, fair in one, and a failure in two. One knee that was classified as a failure showed excellent stability, but the patient had significant pain from chondromalacia of the patella, while significant pain and hyperesthesia from a neuroma was the reason for failure in the second patient.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				N. Saupe, L. M. White, M. M. Chiavaras, J. Essue, I. Weller, M. Kunz, M. Hurtig, and P. Marks Anterior Cruciate Ligament Reconstruction Grafts: MR Imaging Features at Long-term Follow-up--Correlation with Functional and Clinical Evaluation Radiology, September 3, 2008; (2008) 2492071651. [Abstract] [Full Text]

				A. M. Bhosale and J. B. Richardson Articular cartilage: structure, injuries and review of management Br. Med. Bull., August 1, 2008; (2008) ldn025v1. [Abstract] [Full Text] [PDF]

				M. E. Steiner, M. M. Murray, and S. A. Rodeo Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement Am. J. Sports Med., January 1, 2008; 36(1): 176 - 189. [Abstract] [Full Text] [PDF]

				F. Mauch, G. Apic, U. Becker, and G. Bauer Differences in the Placement of the Tibial Tunnel During Reconstruction of the Anterior Cruciate Ligament With and Without Computer-Assisted Navigation Am. J. Sports Med., November 1, 2007; 35(11): 1824 - 1832. [Abstract] [Full Text] [PDF]

				J. F. Heming, J. Rand, and M. E. Steiner Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., October 1, 2007; 35(10): 1708 - 1715. [Abstract] [Full Text] [PDF]

				N. Upadhyay, S. R. Vollans, B. B. Seedhom, and R. W. Soames Effect of Patellar Tendon Shortening on Tracking of the Patella Am. J. Sports Med., October 1, 2005; 33(10): 1565 - 1574. [Abstract] [Full Text] [PDF]

				G. Barrett, D. Stokes, and M. White Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years: Allograft Versus Autograft Patellar Tendon Am. J. Sports Med., October 1, 2005; 33(10): 1505 - 1512. [Abstract] [Full Text] [PDF]

				D. S. Mastrokalos, J. Springer, R. Siebold, and H. H. Paessler Donor Site Morbidity and Return to the Preinjury Activity Level After Anterior Cruciate Ligament Reconstruction Using Ipsilateral and Contralateral Patellar Tendon Autograft: A Retrospective, Nonrandomized Study Am. J. Sports Med., January 1, 2005; 33(1): 85 - 93. [Abstract] [Full Text] [PDF]

				C. P. Bales, J. H. Guettler, and C. T. Moorman III Anterior Cruciate Ligament Injuries in Children With Open Physes: Evolving Strategies of Treatment Am. J. Sports Med., December 1, 2004; 32(8): 1978 - 1985. [Abstract] [Full Text] [PDF]

				K. A. Jansson, E. Linko, J. Sandelin, and A. Harilainen A Prospective Randomized Study of Patellar versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., January 1, 2003; 31(1): 12 - 18. [Abstract] [Full Text] [PDF]

				B. D. Beynnon, R. J. Johnson, B. C. Fleming, P. Kannus, M. Kaplan, J. Samani, and P. Renström Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts : A Prospective, Randomized Study J. Bone Joint Surg. Am., September 3, 2002; 84(9): 1503 - 1513. [Abstract] [Full Text] [PDF]

				K. Sugimoto, Y. Takakura, T. Kumai, M. Iwai, and Y. Tanaka Reconstruction of the Lateral Ankle Ligaments with Bone-Patellar Tendon Graft in Patients with Chronic Ankle Instability : A Preliminary Report Am. J. Sports Med., May 1, 2002; 30(3): 340 - 346. [Abstract] [Full Text] [PDF]

				Y.-F. Hsieh, L. F. Draganich, S. H. Ho, and B. Reider The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on the Contact Characteristics of the Patellofemoral Joint Am. J. Sports Med., January 1, 2002; 30(1): 121 - 127. [Abstract] [Full Text] [PDF]

				M. R. Hutchinson and T. S. Bae Reproducibility of Anatomic Tibial Landmarks for Anterior Cruciate Ligament Reconstructions Am. J. Sports Med., November 1, 2001; 29(6): 777 - 780. [Abstract] [Full Text] [PDF]

				A. F. Anderson, R. B. Snyder, and A. B. Lipscomb Jr Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study of Three Surgical Methods Am. J. Sports Med., May 1, 2001; 29(3): 272 - 279. [Abstract] [Full Text] [PDF]

				R. Katsuragi, K. Yasuda, J. Tsujino, M. Keira, and K. Kaneda The Effect of Nonphysiologically High Initial Tension on the Mechanical Properties of In Situ Frozen Anterior Cruciate Ligament in a Canine Model Am. J. Sports Med., January 1, 2000; 28(1): 47 - 56. [Abstract] [Full Text] [PDF]

				M. D. Miller and A. D. Olszewski The Appearance of Roofplasties on Lateral Hyperextension Radiographs Am. J. Sports Med., July 1, 1999; 27(4): 513 - 516. [Abstract] [Full Text] [PDF]

				L. F. Draganich, Y.-F. Hsieh, S. Ho, and B. Reider Intraarticular Anterior Cruciate Ligament Graft Placement on the Average Most Isometric Line on the Femur: Does It Reproducibly Restore Knee Kinematics? Am. J. Sports Med., May 1, 1999; 27(3): 329 - 334. [Abstract] [Full Text] [PDF]

				T. A. Mann, K. P. Black, D. J. Zanotti, M. Barr, and T. Teater The Natural History of the Intercondylar Notch After Notchplasty Am. J. Sports Med., March 1, 1999; 27(2): 181 - 188. [Abstract] [Full Text] [PDF]

				T. W. Wilson, M. P. Zafuta, and M. Zobitz A Biomechanical Analysis of Matched Bone-Patellar Tendon-Bone and Double-Looped Semitendinosus and Gracilis Tendon Grafts Am. J. Sports Med., March 1, 1999; 27(2): 202 - 207. [Abstract] [Full Text] [PDF]

				T. Muellner, A. Egkher, A. Nikolic, M. Funovics, and V. Metz Open Meniscal Repair: Clinical and Magnetic Resonance Imaging Findings After Twelve Years Am. J. Sports Med., January 1, 1999; 27(1): 16 - 20. [Abstract] [Full Text] [PDF]

				H. U. Staubli, L. Schatzmann, P. Brunner, L. Rincon, and L.-P. Nolte Mechanical Tensile Properties of the Quadriceps Tendon and Patellar Ligament in Young Adults Am. J. Sports Med., January 1, 1999; 27(1): 27 - 34. [Abstract] [Full Text] [PDF]

				A. R. J. Manktelow, F. S. Haddad, and N. J. Goddard Late Lateral Femoral Condyle Fracture After Anterior Cruciate Ligament Reconstruction. A Case Report Am. J. Sports Med., July 1, 1998; 26(4): 587 - 590. [Full Text] [PDF]

				D. Otto, L. A. Pinczewski, A. Clingeleffer, and R. Odell Five-Year Results of Single-Incision Arthroscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft Am. J. Sports Med., March 1, 1998; 26(2): 181 - 188. [Abstract] [Full Text] [PDF]

				Y.-F. Hsieh, L. F. Draganich, S. H. Ho, and B. Reider The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics Am. J. Sports Med., March 1, 1998; 26(2): 201 - 209. [Abstract] [Full Text] [PDF]

				K. D. Shelbourne and T. Gray Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft Followed by Accelerated Rehabilitation: A Two- to Nine-Year Followup Am. J. Sports Med., December 1, 1997; 25(6): 786 - 795. [Abstract] [PDF]

				M. D. Miller and A. D. Olszewski Posterior Tibial Tunnel Placement to Avoid Anterior Cruciate Ligament Graft Impingement by the Intercondylar Roof: An In Vitro and In Vivo Study Am. J. Sports Med., December 1, 1997; 25(6): 818 - 822. [Abstract] [PDF]

				C. B. FRANK and D. W. JACKSON Current Concepts Review - The Science of Reconstruction of the Anterior Cruciate Ligament J. Bone Joint Surg. Am., October 1, 1997; 79(10): 1556 - 76. [Full Text]

				W. Maletius and J. Gillquist Long-term Results of Anterior Cruciate Ligament Reconstruction with a Dacron Prosthesis: The Frequency of Osteoarthritis After Seven to Eleven Years Am. J. Sports Med., June 1, 1997; 25(3): 288 - 293. [Abstract] [PDF]

				K. D. Shelbourne and R. V. Trumper Preventing Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., January 1, 1997; 25(1): 41 - 47. [Abstract] [PDF]

				K. Yasuda, J. Tsujino, Y. Tanabe, and K. Kaneda Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament Reconstruction: Autogenous Doubled Hamstring Tendons Connected in Series with Polyester Tapes Am. J. Sports Med., January 1, 1997; 25(1): 99 - 106. [Abstract] [PDF]

				K. L. MARKOLF, D. M. BURCHFIELD, M. M. SHAPIRO, B. R. DAVIS, G. A. M. FINERMAN, and J. L. SLAUTERBECK Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part I: Insertion of the Graft and Anterior-Posterior Testing J. Bone Joint Surg. Am., November 1, 1996; 78(11): 1720 - 7. [Abstract] [Full Text]

				D. W. Jackson, T. M. Simon, W. Lowery, and E. Gendler Biologic Remodeling after Anterior Cruciate Ligament Reconstruction Using a Collagen Matrix Derived from Demineralized Bone: An Experimental Study in the Goat Model Am. J. Sports Med., July 1, 1996; 24(4): 405 - 414. [Abstract] [PDF]

				M. Samuelson, L. F. Draganich, Xiadong Zhou, P. Krumins, and B. Reider The Effects of Knee Reconstruction on Combined Anterior Cruciate Ligament and Anterolateral Capsular Deficiencies Am. J. Sports Med., July 1, 1996; 24(4): 492 - 497. [Abstract] [PDF]

				A. Maeda, K. Shino, S. Horibe, K. Nakata, and G. Buccafusca Anterior Cruciate Ligament Reconstruction with Multistranded Autogenous Semitendinosus Tendon Am. J. Sports Med., July 1, 1996; 24(4): 504 - 509. [Abstract] [PDF]

				E. E. Khalfayan, P. F. Sharkey, A. H. Alexander, J. D. Bruckner, and E. B. Bynum The Relationship Between Tunnel Placement and Clinical Results After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., June 1, 1996; 24(3): 335 - 341. [Abstract] [PDF]

				R. A. Majors and B. Woodfin Achieving Full Range Of Motion After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., June 1, 1996; 24(3): 350 - 355. [Abstract] [PDF]

				T. S. Samuelson, D. Drez Jr., and G. B. Maletis Anterior Cruciate Ligament Graft Rotation: Reproduction of Normal Graft Rotation Am. J. Sports Med., January 1, 1996; 24(1): 67 - 71. [Abstract] [PDF]

				D. M. Lintner, S. E. Dewitt, and J. B. Moseley Radiographic Evaluation of Native Anterior Cruciate Ligament Attachments and Graft Placement for Reconstruction: A Cadaveric Study Am. J. Sports Med., January 1, 1996; 24(1): 72 - 78. [Abstract] [PDF]

				G. Y. F. Ng, B. W. Oakes, l. D. McLean, O. W. Deacon, and D. Lampard The Long-Term Biomechanical and Viscoelastic Performance of Repairing Anterior Cruciate Ligament after Hemitransection Injury in a Goat Model Am. J. Sports Med., January 1, 1996; 24(1): 109 - 117. [Abstract] [PDF]

				M. Marcacci, S. Zaffagnini, F. Iacono, M. Pia Neri, and A. Petitto Early Versus Late Reconstruction for Anterior Cruciate Ligament Rupture: Results After Five Years of Followup Am. J. Sports Med., December 1, 1995; 23(6): 690 - 693. [Abstract] [PDF]

				K. Yasuda, J. Tsujino, Y. Ohkoshi, Y. Tanabe, and K. Kaneda Graft Site Morbidity with Autogenous Semitendinosus and Gracilis Tendons Am. J. Sports Med., December 1, 1995; 23(6): 706 - 714. [Abstract] [PDF]

				K. Pierz, M. Baltz, and J. Fulkerson The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts Am. J. Sports Med., June 1, 1995; 23(3): 332 - 335. [Abstract] [PDF]

				L. F. Draganich, Y.-F. Hsieh, and B. Reider Iliotibial Band Tenodesis: A New Strategy for Attachment Am. J. Sports Med., March 1, 1995; 23(2): 186 - 195. [Abstract] [PDF]

				A. F. Anderson, R. B. Snyder, and A. B. Lipscomb Sr. Anterior Cruciate Ligament Reconstruction Using the Semitendinosus and Gracilis Tendons Augmented by the Losee Iliotibial Band Tenodesis: A Long-term Study Am. J. Sports Med., September 1, 1994; 22(5): 620 - 626. [Abstract] [PDF]

				J. A. Karlson, M. E. Steiner, C. H. Brown, and J. Johnston Anterior Cruciate Ligament Reconstruction Using Gracilis and Semitendinosus Tendons: Comparison of Through-the-condyle and Over-the-top Graft Placements Am. J. Sports Med., September 1, 1994; 22(5): 659 - 666. [Abstract] [PDF]

				R. A. Rubinstein JR, K. D. Shelbourne, C. D. VanMeter, J. C. McCarroll, and A. C. Rettig Isolated Autogenous Bone-Patellar Tendon-Bone Graft Site Morbidity Am. J. Sports Med., June 1, 1994; 22(3): 324 - 327. [Abstract] [PDF]

				F. T. Blevins, A. T. Hecker, G. T. Bigler, A. L. Boland, and W. C. Hayes The Effects of Donor Age and Strain Rate on the Biomechanical Properties of Bone-Patellar Tendon-Bone Allografts Am. J. Sports Med., June 1, 1994; 22(3): 328 - 333. [Abstract] [PDF]

				P. Aglietti, R. Buzzi, G. Zaccherotti, and P. De Biase Patellar Tendon Versus Doubled Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., March 1, 1994; 22(2): 211 - 218. [Abstract] [PDF]

				E. M. Wojtys and L. J. Huston Neuromuscular Performance in Normal and Anterior Cruciate Ligament-Deficient Lower Extremities Am. J. Sports Med., January 1, 1994; 22(1): 89 - 104. [Abstract] [PDF]

				M. R. Colville and R. R. Bowman The significance of isometer measurements and graft position during anterior cruciate ligament reconstruction Am. J. Sports Med., December 1, 1993; 21(6): 832 - 835. [Abstract] [PDF]

				E. Solheim and T. Strand Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach Am. J. Sports Med., July 1, 1993; 21(4): 507 - 509. [Abstract] [PDF]

				T. H. Gertel, W. D. Lew, J. L. Lewis, N. J. Stewart, and R. E. Hunter Effect of anterior cruciate ligament graft tensioning direction, magnitude, and flexion angle on knee biomechanics Am. J. Sports Med., July 1, 1993; 21(4): 572 - 581. [Abstract] [PDF]

				K. Shino, K. Nakata, S. Horibe, M. Inoue, and S. Nakagawa Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction: Allograft versus autograft Am. J. Sports Med., July 1, 1993; 21(4): 609 - 616. [Abstract] [PDF]

				J. Gillquist and M. Odensten Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis: A prospective study Am. J. Sports Med., June 1, 1993; 21(3): 358 - 366. [Abstract] [PDF]

				V. M. Romano, B. K. Graf, J. S. Keene, and R. H. Lange Anterior cruciate ligament reconstruction: The effect of tibial tunnel placement on range of motion Am. J. Sports Med., June 1, 1993; 21(3): 415 - 418. [Abstract] [PDF]

B. S. Shaffer and J. E. Tibone Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon Am. J. Sports Med., June 1, 1993; 21(3): 449 - 454. [Abstract] [PDF]