[The MacIntosh extra-articular knee stabilisation procedure -- an alternative after failed ACL reconstruction?]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Chronic knee instability is a significant problem following anterior cruciate ligament (ACL) loss and failed reconstruction.
• Minimizing the subjective feeling of instability is paramount for patient quality of life.
• Extra-articular techniques offer an alternative when autologous material is unavailable or the knee joint is compromised.

Purpose of the Study:

• To evaluate the efficacy of a modified MacIntosh extra-articular procedure for chronic knee instability.
• To assess the impact on subjective instability, clinical outcomes, and return to sports after failed ACL reconstruction.

Main Methods:

• A modified MacIntosh procedure using the iliotibial tract was performed on nine patients with failed ACL reconstruction.
• Patients underwent physiotherapy with full weight-bearing post-surgery, with range of motion limited for six weeks.
• Prospective evaluation included pivot-shift and Lachman tests, Lysholm and Tegner scores, and sporting ability assessment.

Main Results:

• The modified MacIntosh procedure significantly improved Lysholm (55.55 to 82.44) and Tegner (1.44 to 3.55) scores (p < .008).
• Subjective instability was reduced in all patients, and the Lachman test showed reduced anterior drawer.
• All patients were able to participate in sports activities at a mean follow-up of 11.4 months.

Conclusions:

• Extra-articular procedures, like the modified MacIntosh technique, are effective alternatives for persistent knee instability after failed ACL reconstruction.
• The modified MacIntosh procedure is technically straightforward, less invasive, and yields encouraging medium-term results.
• This technique successfully addresses subjective instability and facilitates return to athletic activities.