Intra-articular reconstruction of the anterior cruciate ligament with and without extra-articular supplementation by transfer of the biceps femoris tendon.

In a retrospective study to determine whether the efficacy of intra-articular reconstruction of the anterior cruciate ligament is improved by an extra-articular transfer of the biceps femoris tendon, we compared the results in a group of forty-three patients in whom the advancement procedure had been done with those in a group of fifty patients in whom it had not. The minimum length of follow-up was twenty-four months. There was no significant difference between the two groups, and we concluded that advancement of the biceps femoris tendon does not improve the efficacy of an intra-articular reconstruction of the anterior cruciate ligament.

Polypropylene braid augmented and nonaugmented intraarticular anterior cruciate ligament reconstruction.

The purpose of this clinical retrospective study is to determine whether a polypropylene braid (PB) used to augment an intraarticular autograft to reconstruct the anterior cruciate ligament (ACL) is safe and to determine whether the PB improves the efficacy of the procedure. A simultaneous review was performed of patients who had undergone an intraarticular ACL reconstruction using an autograft composed of the central quadriceps tendon, prepatellar periosteum, and patellar tendon left attached distally to the tibial tubercle and of patients who had undergone the same procedure with PB augmentation of the autograft. Preoperatively, all patients had chronic ACL insufficiency and were experiencing symptomatic giving way. A subjective questionnaire and a physician examination (JHR) were completed on each patient. Objective laxity and functional testing, including KT 1000 arthrometer measurement, Cybex isokinetic strength analysis, and one leg horizontal hop for distance, were performed. Six radiographs of each operated knee were obtained. Results were statistically analyzed. Thirty-eight of 43 (88%) nonaugmented procedures performed were reviewed, with a mean followup of 64 months. Forty-five of 48 (94%) PB augmented reconstructions with a minimum followup of 42 months (maximum 57 months, mean 50 months), were reviewed. On objective laxity and function testing, the PB augmented patients had better results than the nonaugmented patients. On subjective questioning, physician's examination, and radiographic analysis, the PB augmented results were significantly better. There were 12 (32%) knees with recurrent symptomatic giving way in the nonaugmented group and 5 (11%) in the PB augmented group. Chrondromalacia patellae and arthrofibrosis were seen in both groups. No adverse reaction to the PB was seen. We conclude that the PB is safe and that PB augmentation improves the efficacy of the intraarticular autograft to reconstruct the ACL.