The technique of cruciate ligament reconstruction

Our technique of reconstruction of the anterior and posterior cruciate ligament in both acute and chronic tears, using both the semitendinosus and gracilis tendons, is described in detail. Combined rotatory instabilities were carefully evaluated and corrected during the same operation. Reefing of the posteromedial capsular ligament was done for anteromedial rotatory instability, and for significant valgus instability, the O'Donoghue medial reconstruction was performed. The Ellison procedure was initially done for associated anterolateral rotatory instability, but has been replaced by the Losee procedure. This combination of anterior cruciate ligament reconstruction with the appropriate extraarticular procedures has produced our most stable knee joints. Posterior cruciate ligament reconstruction was also performed through an anterior incision using both the semitendinosus and gracilis tendons. When both cruciates were found to be incompetent, the gracilis was used to reconstruct the posterior cruciate and the semitendinosus for the anterior cruciate. In addition, all associated rotatory instabilities were corrected at the same operation. This technique has been performed on 372 patients (342 anterior and 30 posterior cruciate ligament tears) by one surgeon over a period of five years. The average follow-up was 22 months. Objective comparison of the reconstructed knee with the sound knee showed 84% good results.