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The Journal of Bone and Joint Surgery, Vol 76, Issue 7 1019-1031, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Use of allografts after failed treatment of rupture of the anterior cruciate ligament
FR Noyes, SD Barber-Westin and CS Roberts
Cincinnati Sportsmedicine and Orthopaedic Center, Ohio.
A prospective study was done of the use of allogeneic tissue to reconstruct
the anterior cruciate ligament in knees in which an intra-articular or an
extra-articular operation had failed. Sixty-six consecutive patients
(sixty-six knees) had such an operation with use of bone-patellar
ligament-bone allografts; all but one returned for follow-up evaluation
twenty-three to seventy-eight months (mean, forty-two months) after the
operation. A total of 235 previous operations had been performed in these
sixty-six knees, including eighty-one procedures for rupture of the
anterior cruciate ligament. The results of the allograft procedure were
evaluated with a subjective and objective system that rated twenty factors.
The anterior-posterior displacement was substantially improved in most of
the patients. According to data derived from arthrometric studies and
pivot-shift tests of the fifty-seven patients who were so evaluated and in
whom the condition was unilateral, 53 per cent (thirty) of the
reconstructed ligaments were determined to be functional; 21 per cent
(twelve ligaments), partially functional; and 26 per cent (fifteen
ligaments), a failure. When we calculated the rate of failure by including
ten failures that had occurred within two years after the operation with
the fifteen that occurred in patients who had been followed for at least
two years, the over-all rate of failure was 33 per cent (twenty-five of
seventy-five operations). There was significant improvement in the
subjective ratings of functional limitations and symptoms (p < 0.01) and
in the over-all rating score (p < 0.0001). However, there was a
significant difference between the scores of the patients in whom the
surfaces of the articular cartilage had appeared normal at the index
operation and those of the patients in whom there had been noteworthy
fissuring and fragmentation or exposure of subchondral bone. After the
program of rehabilitation, which included immediate motion of the knee, a
range of motion of 0 to 135 degrees was restored in all but five knees,
four of which lacked only 5 degrees of this extent of flexion or extension.
The results demonstrate that bone-patellar ligament-bone allografts may be
used when proper autogenous tissues are not available and that symptoms and
abnormal displacement were reduced in most of our patients.
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