Document Title: Wascher-AJSM-Mar99

Author: Daniel C. Wascher, MD, Jeremy R. Becker, MD, James G. Dexter, RPT and Field T. Blevins, MD Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico
Presented at the 2nd World Congress on Sports Trauma/AOSSM 22nd annual meeting, June 1996, Lake Buena Vista, Florida.
Address correspondence and reprint requests to Daniel C. Wascher, MD, University of New Mexico, Health Sciences Center, School of Medicine, Department of Orthopaedics, ACC 2 West, Albuquerque, NM 87131-5296

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: July-August 1999.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 27

Issue: 2

Pages: 189-196

Key Words: Knee, ACL, PCL, allograft, chronic, ligamentization.

(Figures included. Reference-denoting numbers appear in the same point size as the document text.)

Comments: Wascher et al. describe a series of cases in which allografts were used to reconstruct knees in which both cruciate ligaments were fully torn. They achieved good results, but noted that complete regainment pre-injury knee function, especially given the severe injuries of these knees, was difficult to attain. It was noted that promptly-performed reconstructions (e.g. within 3 months of the injury) yielded results superior to those of delayed reconstructions. (The reason for the three-month time limit is because in a chronically ACL-deficient knee, the secondary restraints [most notably the posterolateral structures] tend to stretch out over a period of months and years. This means that a knee which has been ACL-deficient for an extended period of time will be more loose overall than a knee which incurred the exact same injury six weeks ago. [Similar concerns apply in the case of PCL deficiencies.] Because allografts take roughly twice as long to ligamentize as autografts, allografts are likely to stretch out and fail if used in an extremely loose knee. For such chronically deficient knees, the most reliable option is always the patellar-tendon autograft, due to the presence of bone plugs at both ends. No other graft option brings the security and fast ligamentization provided by bone-plug-to-bone-tunnel healing at both ends of the graft.)

ABSTRACT

We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3° (range, 0° to 10°) and average flexion loss was 5° (range, 0° to 15°). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20° and 5.0 mm (range, 0 to 9) at 70°. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.

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