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The Journal of Bone and Joint Surgery, Vol 73, Issue 6 882-892, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
The effect of an extra-articular procedure on allograft reconstructions for chronic ruptures of the anterior cruciate ligament
FR Noyes and SD Barber
Cincinnati Sportsmedicine and Orthopaedic Center, Deaconess Hospital, Ohio 45219.
A study was performed on the effect of the addition of an extra-articular
procedure involving tenodesis of the iliotibial band to a reconstruction
with a bone-patellar ligament-bone allograft for the treatment of chronic
rupture of the anterior cruciate ligament. One hundred and four patients
were divided into two groups for comparison: Group 1 (sixty-four patients)
was treated with only an intra-articular replacement with an allograft and
Group 2 (forty patients), with both an intra-articular replacement with an
allograft and the extra-articular procedure. Preoperatively, there were no
statistically significant differences between the two groups in terms of
twenty variables, including body weight, level of activity,
anterior-posterior displacements, number of previous operations, and
duration of follow-up. All of the patients returned for follow-up
evaluation twenty-three to fifty-four months (mean, thirty-five months)
postoperatively. All were treated with the same postoperative program of
immediate motion of the knee and rehabilitation. The results were evaluated
with the use of a comprehensive subjective and objective system that rated
the twenty factors. Both procedures proved to be effective in decreasing
functional limitations and symptoms and in improving the level of sports
activity and the over-all scores. The results in Group 2 were significantly
better than those in Group 1, as measured with tests done with the KT-1000
arthrometer (p less than 0.01) and with regard to the level of sports
activity (p less than 0.05) and the over-all scores (p less than 0.01).
There was no postoperative difference between the two groups in terms of
the results on pivot-shift or isokinetic testing, patellofemoral crepitus,
functional limitations, or symptoms. The program of rehabilitation
effectively restored 0 to 135 degrees of motion to all but four knees,
which lacked 5 degrees of extension at the most recent follow-up. The
over-all rate of failure for both groups was 11 per cent. However, the rate
of failure was 16 per cent (ten of sixty-four knees) in Group 1 and only 3
per cent (one of forty knees) in Group 2. This difference was significant
(p less than 0.05). The extra-articular procedure appeared to provide
support to the healing intra-articular allograft by reducing deleterious
forces and tibial displacements, and to restore the secondary restraints
provided by the lateral iliotibial band. The results suggest that the
combination of the procedures is of value in young, athletically active
people who have chronic rupture of the anterior cruciate ligament.(ABSTRACT
TRUNCATED AT 400 WORDS)
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