Vascularized patella tendon anterior cruciate ligament reconstruction

Forty-seven patients with a chronic anterior cruciate ligament (ACL) deficiency were treated with patella tendon ACL reconstructions from July 1980 to September 1983. All patients had a minimum two-year follow-up period (range, 24-54 months). Forty-two patients (89%) had meniscal damage in association with the ACL deficiency. This included seven menisci (17%) that had a stable tear and were left in place without suture fixation. Only five patients (11%) had normal menisci at the time of reconstruction. Functional and subjective results were obtained from a questionnaire that included a comprehensive evaluation of patients' symptoms and activities. Objective results were analyzed on the basis of a thorough physical examination, augmented with arthrometer instrumented drawer testing. The detailed questionnaire was returned by 42 patients (89%). Follow-up examinations were obtained for 37 patients (79%), with arthrometer testing of 35 patients (75%). A 100-point rating scale defined objective, subjective, and functional results. Stability testing, using Lachman's test, was judged to be less than or equal to 5 mm of anteroposterior tibiofemoral translation in 51% of the patients examined and less than or equal to 10 mm of translation in 89%. Stability by arthrometer testing was less than or equal to 5 mm side-to-side difference in 83%. No patient lost a menisci after reconstruction. This included six patients with stable tears that were left unsutured. Subjective results were good or better in 60%. Functional results were good or better in 52%, with 41 of 42 patients participating in some form of recreational sports postoperatively. There was a large discrepancy between objective findings and the subjective and functional results (14% poor results compared with 31% and 43%, respectively). Although objective stability could be surgically restored in an ACL-deficient knee, the quality of the knee at the time of reconstruction as well as the postoperative and rehabilitative regimen are implicated in patients with poor subjective and functional results.