Anterior cruciate ligament replacement using part of the patellar tendon as a free graft

The operative result in 91 patients who had a repair of a ruptured anterior cruciate ligament and replacement with a bone-patellar ligament-bone autogenous graft are analyzed. The average time between initial injury and operation was 2 years. Instability of the knee had been present for 6 months to 6 years and the mean follow up was 4 years. Indications for the intraarticular repair were a positive Pivot shift test and Lachman test and a positive anterior drawer sign at the preoperative examinations while under anesthesia. Seventy percent of the injuries were sports related and the remaining thirty percent injured their knee during work-related activities. Forty-eight percent (44 patients) had an associated meniscal lesion, the majority of which were on the medial side. Eighty percent of the meniscal lesions required partial meniscectomy and 20% were repaired. Eleven percent (10 patients) had an associated chondral lesion while 2 patients had a second degree of chondromalacia of the patella. The results were assessed using the Clancy criteria. Sixty eight percent (62 patients) had an excellent result, 28% (25 patients) very good, and 4 patients fair or good. The Lachman test was negative in 70% of out patients and mildly positive with a firm end point in 30%. The pivot shift test was negative in 71% and mildly positive in 29% of our patients.