Extra-articular reconstructive surgery for combined anterolateral-anteromedial rotatory instability

The knees of 14 patients (12 male and 2 female) were treated surgically by extra-articular reconstruction for combined anterolateral-anteromedial rotatory instability. Healing and rehabilitation required approximately 8 months after the operations. Only after adequate rehabilitation, including return of full confidence, were the patients released to full activity (although contact sports are not recommended). Of the group, 12 patients returned for follow-up evaluations and one returned a questionnaire. One patient was lost to follow-up. One patient did not return to full activity because in the 3rd month postoperatively, he stepped in a hole while jogging, reinjured his knee, and refused further surgery. The functional improvement in this series by our extra-articular procedure (a combination of an anteromedial capsulorrhaphy and pes transfer medially with Ellison's modification of an iliotibial band rerouting and partial biceps advancement laterally) compares favorably with the reported anterior cruciate ligament reconstructions. Further comparisons with longer periods of time after surgical procedures are needed to determine whether extra-articular repair with interarticular reconstruction of the anterior cruciate ligament is significantly better than this technically easier extra-articular repair alone.