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Anterior Cruciate Ligament Reconstruction in Patients Who Have Excessive Joint Laxity

¹ Department of Orthopaedic Surgery, Yonsei University College of Medicine, Shinchon-dong, Seodaemoon-gu, 120-752, Seoul, Republic of Korea. E-mail address for T.-E. Kim: osandrea{at}naver.com

Investigation performed at Yonsei University Arthroscopy and Joint Research Institute and the Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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Methods: We retrospectively studied eighty-three patients (forty-eight men and thirty-five women) who had undergone anterior cruciate ligament reconstruction between June 2002 and August 2004. Of the thirty-one patients who had generalized joint laxity, twenty were managed with an autologous bone-patellar tendon-bone graft and eleven were managed with a four-bundle hamstring (semitendinosus-gracilis tendon) graft. Of the fifty-two patients who had normal joint laxity, thirty-three were managed with a bone-patellar tendon-bone graft and nineteen were managed with a hamstring graft. Clinical results were evaluated by means of an examination at a minimum of twenty-four months after surgery.

Results: Among the patients who had normal joint laxity, the mean side-to-side difference in anterior tibial translation on testing with the KT-2000 arthrometer at a minimum of twenty-four months postoperatively was 2.7 ± 1.9 mm in the bone-patellar tendon-bone graft group and 3.5 ± 1.7 mm in the hamstring graft group. This difference was not significant. The mean Lysholm score was 91 ± 7 points in the bone-patellar tendon-bone graft group and 85 ± 10 points in the hamstring graft group (p = 0.492). The side-to-side difference in anterior translation had an inverse correlation with the Lysholm score (β = –0.604, p < 0.001). Among the patients who had excessive joint laxity, the mean side-to-side difference in anterior tibial translation was 3.4 ± 1.5 mm in the bone-patellar tendon-bone graft group and 4.5 ± 2.0 mm in the hamstring graft group (p = 0.036). The mean Lysholm score was 89 ± 7 points in the bone-patellar tendon-bone group and 79 ± 12 points in the hamstring group (p = 0.015). The side-to-side difference in anterior translation had an inverse correlation with the Lysholm score (β = –0.708, p < 0.001).

Conclusions: In patients who have excessive joint laxity, the two-year outcomes of anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts are better than those with four-bundle hamstring grafts in terms of both side-to-side anterior laxity and clinical results.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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