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The Journal of Bone and Joint Surgery, Vol 68, Issue 2 160-177, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract
B Zarins and CR Rowe
We are reporting the results of a reconstructive procedure designed to
decrease anterior tibial subluxation due to disruption of the anterior
cruciate ligament. The operation combines both intra-articular and
extra-articular methods. The semitendinosus tendon and the iliotibial tract
are both routed from opposite directions over the top of the lateral
femoral condyle and through the same oblique drill-hole in the proximal
part of the tibia: the semitendinosus tendon is passed up through the
tibial drill-hole, across the knee joint, over the top of the lateral
femoral condyle, and deep to the fibular collateral ligament, and the
iliotibial tract is passed deep to the fibular collateral ligament, over
the top of the lateral femoral condyle, across the knee joint, and down
through the drill-hole. Both grafts are simultaneously pulled tight while
the semitendinosus tendon is sutured to the iliotibial tract laterally and
the iliotibial tract is sutured to the semitendinosus tendon medially below
the drill-hole. The posteromedial and lateral parts of the capsule are
advanced to tighten the secondary restraints. One hundred of the first 106
consecutive patients with chronic instability who had this procedure were
evaluated using subjective and objective criteria at three to seven and
one-half years after surgery. The positive anterior-drawer sign tested at
25 degrees of flexion was eliminated or reduced to 1+ in eighty knees, and
the positive pivot shift was reduced to zero or 1+ in ninety-one knees. The
objective assessment of isokinetic muscle performance and passive tibial
rotation showed significant improvements in strength and normalization of
tibial rotation.
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