Reconstruction of the anterior cruciate ligament using free tendon graft

Twenty-seven patients were treated with an intraarticular tendon graft reconstruction of the anterior cruciate ligament. The tendon of the extensor of the fifth toe was used in five patients and the tendon of the semi-tendinosus muscle used in 22 patients. Followup ranged from 2 to 9 years, averaging 5.4 years. Fifteen patients remained pain-free, nine complained of only occasional ache, and three had more severe discomfort. One of those patients ruptured the graft postoperatively. Twenty patients were able to return to recreational sports and three to competitive sports. All patients were able to return to their previous occupations. Nine patients had evidence of severe or moderately severe arthritic changes in the injured knee prior to surgery, and an additional five patients had chondromalacia or early arthritic changes. The severity of arthritic changes was directly related to the time interval between injury and reconstruction of the ligament and also to the severity of the injury. Patients with arthritic changes greatly benefited from reconstruction of the ligament. The stability of the reconstructed ligament did not change during the followup if integrity of other ligaments was preserved or reconstructed.