A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts

This paper reports the results of our approach to ACL tears and knee laxity, based on 30 years of experience in ACL reconstruction with hamstrings and founded on the following cornerstones: the use of doubled semitendinosus and gracilis as a free graft; the use of an out-in technique for femoral drilling and of very strong and stiff fixation devices; the careful examination and repair or reconstruction of the lateral compartment in selected patients; and the use of unaggressive rehabilitation. We prospectively evaluated a series of 100 consecutive patients who underwent ACL reconstruction between 2001 and 2002. A clinical and radiological follow-up was performed at a minimum of 6 years. After 6 years, the International Knee Documentation Committee score demonstrated good-to-excellent results (A and B) in 98% of patients. However, arthrometric results using the KT-1000 demonstrated that 6/80 patients (7.5%) had >5 mm manual maximum side-to-side difference. The median Tegner activity score was 5 (range 1-9); the median Lysholm score was 96 (range 81-100); and the median subjective IKDC score was 94 (range 66-100). We reported 6/80 failures as revealed by a 2+ or 3+ pivot-shift test result and/or KT-1000 side-to-side difference of more than 5 mm. The IKDC score revealed excellent results in all women who underwent extra-articular tenodesis. Radiographic evaluation demonstrated early signs of osteoarthritis in 9% of patients.