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The Journal of Bone and Joint Surgery, Vol 71, Issue 7 965-974, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament. A randomized study with long-term follow-up
C Andersson, M Odensten, L Good and J Gillquist
Department of Orthopaedic Surgery, University Hospital, Linkoping Sweden.
One hundred and eleven consecutive patients who had acute injuries to the
knee that included rupture of the anterior cruciate ligament, as shown by
physical examination with the patient under anesthesia and by diagnostic
arthroscopy, were randomized to three treatment groups: simple repair of
all injured structures, repair of all injured structures and augmentation
of the anterior cruciate ligament with a strip of the iliotibial band, and
repair of all injured structures except the anterior cruciate ligament. In
all other respects, the knees were treated in an identical fashion. Of the
111 patients, 107 were re-examined forty-five months or more after
operation. At the most recent follow-up, the knees that had been treated by
repair and augmentation of the anterior cruciate ligament were
significantly more stable and had had significantly fewer subsequent
meniscal tears. Sufficient instability to necessitate late reconstruction
was also less frequent in the patients who had had an augmented repair.
These patients had better function of the knee and a higher level of
activity than the patients in the other two groups. Sixty-four per cent of
these patients who had a rupture of the anterior cruciate also had a
meniscal tear, and primary care was indicated for more than 50 per cent of
the tears. Therefore, we believe that early arthroscopic examination is
essential for patients who have an acute rupture of the anterior cruciate
ligament.
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