Arthroscopic evaluation of allograft anterior cruciate ligament reconstruction

Abstract

In a previous study, we evaluated the findings of arthroscopic second looks at open anterior cruciate ligament reconstructions using autogenous tissue. We were disappointed at the variable quality of the ligaments and the presence of articular cartilage lesions. These findings led us to change our treatment protocol. Since 1983, we have used freeze-dried allografts for arthroscopic intraarticular ACL reconstructions. We have started protected motion in a brace immediately postoperatively and delayed weightbearing for 12–16 weeks. A total of 54 patients with at least a 2-year follow-up were evaluated subjectively (Lysholm scale) and objectively (KT 1000). Some 78% were rated good or excellent, and 87% were satisfied with their surgery. Of these 54 patients, 28 underwent subsequent surgery for hardware removal, manipulation, or removal of adhesions. All 28 had an arthroscopy, and an evaluation of ligamentous tissue and articular cartilage at the time of the second surgery. The graft resembled a normal anterior cruciate ligament in 18 patients. The graft was slightly lax in two of these patients, but their clinical examination revealed normal stability. In six patients, the intercondvlar notch was covered by a sheath of dense, fibrous tissue, but the knees were stable. In two cases, there was slight fraying of the lateral aspect of the graft from impingement on the lateral femoral condyle. In two cases the graft failed. The condition of the articular cartilage was documented and compared with the condition of the articular cartilage at the time of cruciate reconstruction. In 19 cases, the articular cartilage had been normal and remained normal at the time of reevaluation. There were two instances of deterioration of the articular cartilage of the patella and one instance of deterioration of the trochlear groove. There were six instances of deterioration of the articular cartilage in the medial compartment. In four of these cases, a partial medial meniscectomy had been performed prior to or at the time of the ACL reconstruction. The articular cartilage in the lateral compartment remained normal in all cases. We are encouraged by the clinical and arthroscopic findings using this technique. The instance of articular cartilage deterioration markedly decreased using an arthroscopic technique for reconstruction and early motion. Partial medial meniscectomy appears to correlate with subsequent degenerative changes in the medial compartment.