Results Of Anterior Cruciate Ligament Research Articles

Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Graft

The purpose of this study was to analyze the clinical results of anterior cruciate ligament (ACL) reconstruction with the remnant-preserving technique by use of a hamstring graft and looped sutures according to the amount of the tibial remnant of the ACL. Sixteen subjects had undergone ACL reconstruction with the remnant-preserving technique by use of 4 strands of a hamstring tendon and a looped suture technique and were followed up for at least 12 months. The mean follow-up was 35.1 months. At the last follow-up examination, the patients were evaluated with the International Knee Documentation Committee scale and Hospital for Special Surgery score as subjective tests; stress radiographs, Lachman test, and anterior drawer test by use of the KT-2000 arthrometer (MEDmetric, San Diego, CA) as objective tests; and single-legged hop test, reproduction of passive positioning, threshold to detection of passive motion, and single-limb standing test as functional tests. On the basis of the extent of ACL remnant, patients were then divided into 2 groups. Group I comprised patients with more than 20%, and group II comprised those with less than 20%. For each of the 2 groups, a statistical comparison of the final results was made. The mean Hospital for Special Surgery score improved from 65.8 (preoperatively) to 95.2 (at last follow-up). Functional evaluation revealed that the difference was not significant in terms of mechanical stability, but a significant difference was detected in functional outcome and proprioception. Regarding the threshold to detection of passive motion at 30 degrees (P = .030) and reproduction of passive positioning at 15 degrees (P = .032) and 30 degrees (P = .024), group I (> 20%) showed better results than group II (< 20%). We confirmed that the remnant-preserving technique described showed good proprioceptive and functional outcomes with statistical significance. Therefore it may be expected that the more the tibial remnant is kept intact, the better the preservation of proprioceptive function will be. Level IV, prognostic case series.

Anterior cruciate ligament reconstruction with the peroneous longus tendon

The aim of the study was to evaluate the results of anterior cruciate ligament (ACL) reconstruction using a peroneus longus tendon (PLT) autograft. The study included 29 patients (27 males, 2 females; mean age 30 years; range 21 to 39 years) who underwent ACL reconstruction using a PLT autograft and interference nail fixation. Fourteen patients (48.3%) also had partial meniscectomy during surgery. The results were assessed according to the Lysholm scores and the International Knee Documentation Committee (IKDC) scale at the end of at least five years of follow-up. According to the IKDC scale, 17 patients (58.6%) were rated as normal or nearly normal, and 12 patients (41.4%) were rated as abnormal or severely abnormal. The mean Lysholm score was 83.7 (range 45 to 100), with excellent or good results in 23 patients (79.3%). Radiographic examination showed mild (n=10) or moderate (n=1) degenerative changes in the knee joint. Compared with the normal side, no flexion or extension losses occurred in the affected knees. Stability of the ACL was assessed by the Lachman test, which showed normal findings in 12 patients (41.4%), while nine patients had 1+, five patients had 2+, and three patients had 3+ anteroposterior laxity. Pivot-shift test was negative in 13 patients (44.8%); ten patients had 1+ pivot glide, and six patients had 2+ pivot shift. Two patients (6.9%) complained of mild to moderate pressure pain, paresthesia and dysesthesia at the donor site of PLT. No patient experienced ankle joint dysfunction or difficulty in sports activities due to PLT graft transfer. Our data show that PLT can be an appropriate autograft source for ACL reconstruction, avoiding potential complications of autografts obtained from the knee region.

A 10‐year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial

BACKGROUND: There are no controlled, prospective studies comparing the 10‐year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and four‐strand hamstring tendon (HT) autografts.HYPOTHESIS: Comparable results are possible with HT and PT autografts.STUDY DESIGN: Cohort study; Level of evidence, 2.METHODS: One hundred and eighty ACL‐deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT autograft) by one surgeon and were treated with an accelerated rehabilitation program. All knees were observed in a prospective fashion with subjective, objective, and radiographic evaluation at 2‐, 5‐, 7‐, and 10‐year intervals.RESULTS: At 10 years, there were no differences in graft rupture rates (7/90 PT vs 12/90 HT, P=0.24). There were 20 contralateral ACL ruptures in the PT group, compared with nine in the HT group (P=0.02). In all patients, graft rupture was associated with instrumented laxity &gt;2 mm at 2 years (P=0.001). Normal or near‐normal function of the knee was reported in 97% of patients in both groups. In the PT group, harvest‐site symptoms (P=0.001) and kneeling pain (P=0.01) were more common than in the HT group. More patients reported pain with strenuous activities in PT knees than in HT knees (P=0.05). Radiographic osteoarthritis was more common in PT knees than the HT‐reconstructed knees (P=0.04). The difference, however, was composed of patients with mild osteoarthritis. Other predictors of radiographic osteoarthritis were &lt;90% single‐legged hop test at 1 year and the need for further knee surgery. An “ideal” outcome, defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction, was associated with &lt;3 mm of instrumented laxity at 2 years, the absence of additional surgery in the knee, and HT grafts.CONCLUSIONS: It is possible to obtain excellent results with both HT and PT autografts. We recommend HT reconstructions to our patients because of decreased harvest‐site symptoms and radiographic osteoarthritis.

A 10-Year Comparison of Anterior Cruciate Ligament Reconstructions with Hamstring Tendon and Patellar Tendon Autograft

Background There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts. Hypothesis Comparable results are possible with HT and PT autografts. Study Design Cohort study; Level of evidence, 2. Methods One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT autograft) by one surgeon and were treated with an accelerated rehabilitation program. All knees were observed in a prospective fashion with subjective, objective, and radiographic evaluation at 2, 5, 7, and 10-year intervals. Results At 10 years, there were no differences in graft rupture rates (7/90 PT vs. 12/90 HT, P = .24). There were 20 contralateral ACL ruptures in the PT group, compared with 9 in the HT group (P = .02). In all patients, graft rupture was associated with instrumented laxity >2 mm at 2 years (P = .001). Normal or near-normal function of the knee was reported in 97% of patients in both groups. In the PT group, harvest-site symptoms (P = .001) and kneeling pain (P = .01) were more common than in the HT group. More patients reported pain with strenuous activities in PT knees than in HT knees (P = .05). Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees (P = .04). The difference, however, was composed of patients with mild osteoarthritis. Other predictors of radiographic osteoarthritis were <90% single-legged hop test at 1 year and the need for further knee surgery. An “ideal” outcome, defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction, was associated with <3 mm of instrumented laxity at 2 years, the absence of additional surgery in the knee, and HT grafts. Conclusions It is possible to obtain excellent results with both HT and PT autografts. We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis.

Age and ACL Reconstruction Revisited

To determine the age limitations for indicating ACL reconstructions in patients with functional instability, this article reviews the results of anterior cruciate ligament (ACL) reconstructions in 23 patients with an average age of 54 years (range: 49-64 years). Patients were evaluated with the Lysholm and Gillquist knee questionairre, visual analog scale, satisfaction rating, physical examination, KT-1000 testing, and radiographs. Nineteen of the 23 patients were available for follow-up at an average of 24 months after the index procedure. Sixteen patients returned for physical examination and 3 agreed to telephone interviews. The mean Lysholm score was 92, visual analog score 0.5, satisfaction rating 100%, KT-1000 testing 2mm, range of motion 0 degrees to 135 degees. Sixteen of the 19 patients returned to acceptable activity levels. Fifteen patients had excellent or good results, while 4 patients had fair or poor results. Three of the 4 fair or poor results had significant moderate or severe knee arthrosis. Anterior cruciate ligament reconstruction with allograft in 49-64 year-old patients with minimal arthrosis is a safe, minimally invasive procedure that allows for return to a desired level of activity.

Poster 101: Anterior Cruciate Ligament Rupture Treatment in an Occupational Rehabilitation Environment. A Comparative Study Between Patelar Tendon Versus 4-Strand Gracilis-Semitendinosus Graft

Objective: To compare the outcomes of anterior cruciate ligament (ACL) reconstruction with patellar tendon graft (PTG) versus gracilis-semitendinous graft (GSG) in an occupational rehabilitation environment. Design: Nonrandomized controlled trial. Setting: Occupational rehabilitation department. Participants: 35 patients referred to the occupational PM&R department after ACL reconstruction. ACL injuries were caused by work accidents. Intervention: 20 patients underwent a PTG ACL reconstruction, and 15 underwent a GSG ACL reconstruction. All patients completed an accelerated rehabilitation program. Main Outcome Measures: Knee extension and flexion strength were evaluated with isokinetic tests. Time out of work and rehab treatment length were registered. Level of sports participation and former job return were evaluated. Overall function was assessed through the Lysholm scale. Relevant complications and patient satisfaction were registered. Results: Flexor strength deficit (>15%) was significantly higher (P<.05) in patients treated with GSG. Those patients showed a deficit in 46% of the cases. Only 10% of patients treated with PTG showed knee flexor deficit. The rest of evaluations did not show significant difference between groups. Both groups showed a high rate of extensor deficit (range, 45%–46%). 37% of patients with previous regular sportive activity gave it up. The Lysholm score mean reaches the excellent/good level in both groups. Most patients (97%) returned to their previous workplace. Complication rate was 17%. 63% of patients were highly satisfied with the treatment. Conclusions: ACL reconstruction with a GCG shows no benefits in front of PTG in occupational rehabilitation patients. Rehabilitation strategies should be reevaluated (ie, enhancing the length and intensity of rehab treatment) in order to overcome the high rate of knee extensor deficit and the low levels of return to sport.

Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study

To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n = 34) or a central one-third bone-patella tendon-bone autograft (n = 34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.

Analysis of Outcomes of Anterior Cruciate Ligament Repair With 5-Year Follow-up: Allograft Versus Autograft

To prospectively compare outcomes of primary anterior cruciate ligament (ACL) reconstruction with either Achilles tendon allograft with soft-tissue fixation or standard bone-patellar tendon-bone autograft with interference screw fixation. Prospective comparative case series. A group of 41 patients who underwent soft-tissue allograft reconstruction and a group of 118 patients who underwent autograft bone-patellar tendon-bone reconstruction were included in the final results. Patients were evaluated preoperatively and postoperatively at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and then annually for 5 years. Objective measures of outcome included KT-1000 measurements, range of motion, ligamentous integrity, thigh atrophy, and International Knee Documentation Committee score. Subjective evaluations included patient completion of 5 questionnaires documenting functional status, pain, and health-related quality of life: (1) the short-form McGill Pain Questionnaire, (2) a patient subjective assessment of knee function and symptoms, (3) a patient subjective assessment follow-up, (4) a knee pain scale, and (5) the RAND 36-Item Health Survey. Mixed models analysis of variance was used to compare the outcomes of the treatment groups using baseline values of the study variables as a covariate. Autograft patients reported significantly more pain on the bodily pain subscale of the RAND-36 than the allograft group at 1 week (P = .0006), 6 weeks (P = .0007), and 3 months (P = .0270). Autograft patients reported more pain than allograft patients on the McGill Pain Scale visual analog scale at 1 to 2 weeks (P < .0001) and 6 weeks (P = .0147). Patient assessment of function and symptoms showed that a higher proportion of patients reported normal or nearly normal knee function in the allograft group than in the autograft group at 3 months (33% v 14%, P = .0558, respectively). Fewer activity limitations were reported by allograft patients than autograft patients at 6 weeks (P = .0501), 3 months (P = .0431), and 6 months (P = .0014). After reconstruction, the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the autograft group (P = .0520). These measurements decreased over time for both groups (P < .0001). Five-year follow-up of patients undergoing ACL reconstruction with allograft versus autograft were compared objectively and subjectively. Both groups of patients achieved similar long-term outcomes. Overall, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period. Level II, prospective cohort study.

Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus gracilis and semitendinosus autograft

To evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction in patients with ACL-deficient knee in 2 similar groups of patients. A prospective randomized comparison of patellar tendon (PT) versus semitendinosus and gracilis tendon (STG) autografts for ACL reconstruction. Between 1994 and 1996, 85 consecutive male patients with chronic ACL-deficient knees underwent arthroscopically assisted reconstruction with either autologous PT or double-loop STG (4-strand) graft. PT grafts were used in patients with even-numbered birth dates and STG grafts for those with odd-numbered birth dates. Preoperatively, no significant differences between the 2 groups were noted with respect to age, level of activity, and degree of laxity (chi-square analysis). A standardized rehabilitation program was used for both groups postoperatively that included immediate active extension and early weight bearing and gradual flexion. Return to sports was permitted 8 months postoperatively. Assessment of the patients was carried out using a questionnaire, clinical assessment, Lysholm knee scores, the International Knee Documentation Committee scale, and radiological examination. At a mean follow-up of 81 months, there was no significant difference between the 2 groups with respect to subjective complaints (recurrent giving way, functional level) or objective laxity evaluation, including KT-1000 measurement or return to sports. Loss of extension of < or =5 degrees was greater in the PT group (12 patients, 30 %) than in the STG group (8 patients, 17 %). There was loss of flexion of < or =15 degrees in 5 patients (12 %) in the PT group and 1 patient (2.2 %) in the STG group. Anterior knee pain was recorded in 10 patients (24 %) in the PT group and 3 patients (5 %) in the STG group. The Lysholm knee score was 91.6 and 92.7 for the PT and STG groups, respectively, and the Tegner activity score decreased from 8.9 preoperatively for both groups to 7.9 for the PT group and 7.8 for the STG group. In this study, the 2 groups had comparable results in terms of patient satisfaction, activity level, and knee function. Our study showed that patellofemoral problems and loss of knee motion are more frequent in patients with PT grafts than in those with STG grafts. Level I, Randomized Controlled Trial.

Hamstring anterior cruciate ligament reconstruction: Is it necessary to sacrifice the gracilis?

The purpose of this study was to determine if there was a difference in the clinical results of anterior cruciate ligament (ACL) reconstruction when using the semitendinosus tendon (ST) alone versus the semitendinosus and gracilis (STG) construct. Prospective randomized study. We prospectively followed up a group of 97 patients who underwent reconstruction with either an ST graft (50 patients) or STG graft (47 patients). The patients were evaluated according to standard knee scales (IKDC, Noyes, Lysholm, Tegner), self-evaluation score (SANE), clinical findings, computerized knee laxity analysis, and functional tests. Isokinetic flexion, extension, and internal rotation-external rotation testing were also performed. The results were subjected to statistical analysis. We did not find any significant difference between the 2 groups according to the standard knee scores; self-evaluation score; clinical findings; computerized knee laxity analysis; flexion, extension, and external rotation strengths; or functional tests. However, we did note that the internal rotation torque deficit was significantly higher in the STG group (P = .039). Likewise, the external-to-internal rotation ratio was significantly greater in the STG group (P = .006). Although there is not much clinical difference when using the ST alone versus the STG construct, internal rotation weakness following harvest of 2 tendons may need to be evaluated further. We suggest that, whenever possible, only 1 tendon should be used when performing anterior cruciate ligament reconstruction with hamstring tendons. Level I, Randomized Controlled Study.

Anterior Cruciate Ligament Reconstruction

The choice of graft for anterior cruciate ligament reconstruction is a matter of debate, with patellar and hamstring tendons being the two most popular autologous graft options. The objective of this study was to determine in a prospective, randomized clinical trial whether two grafts (bone-patellar tendon-bone or doubled hamstring tendons) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction.One hundred and twenty patients with a chronic unilateral rupture of the anterior cruciate ligament underwent arthroscopically assisted reconstruction with use of either autologous bone-patellar tendon-bone or doubled hamstring tendon grafts, in a strictly alternating manner. Both groups were comparable with regard to demographic data, preoperative activity level, mechanism of injury, interval between the injury and the operation, and the amount of knee laxity present preoperatively. The same well-proven surgical technique and aggressive controlled rehabilitation was used. An independent observer, who was blinded with regard to the involved leg and the type of graft, performed the outcome assessment with use of a visual analog scale, the new International Knee Documentation Committee form, the Knee Injury and Osteoarthritis Outcome Score, the Functional Knee Score for Anterior Knee Pain, and an arthrometric and an isokinetic dynamometric evaluation. Radiographs were also made.At the two-year follow-up evaluation, no differences were found in terms of the visual analog score, the Knee Injury and Osteoarthritis Outcome Score, the new International Knee Documentation Committee subjective and objective evaluation scores, the KT-1000 side-to-side laxity measurements, the Functional Knee Score for Anterior Knee Pain, muscle strength recovery, or return to sports activities. In the bone-patellar tendon-bone group, we found a higher prevalence of postoperative kneeling discomfort (p < 0.01) and an increased area of decreased skin sensitivity (p < 0.001). In the hamstring tendon group, we recorded a higher prevalence of femoral tunnel widening (p < 0.01). In this group, a correlation was also found between medial meniscectomy and an increased prevalence of pivot-shift glide (p = 0.035).We believe that, with use of accurate and proven surgical and rehabilitation techniques, both grafts are an equivalent option for anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon graft in rugby players.

The purpose of this study was to evaluate prospectively the results of anterior cruciate ligament (ACL) reconstruction with doubled hamstring tendon graft in a selected group of 18 rugby players. The graft was fixed with a transcondylar screw (Transfix) on the femur, and with an absorbable interference screw and a metallic staple on the tibia. All the patients followed the same rehabilitation program. Return to sports activities was allowed after 6 months. Follow-up was 2 years in all cases. The athletic level of the patients was rated according to the Tegner scoring system. Clinical results were evaluated using the International Knee Documentation Committee (IKDC) scoring system. Furthermore, an instrumented evaluation of the anterior laxity with a KT-1000 arthrometer, and an isokinetic evaluation were performed 6 and 24 months after surgery. The Tegner mean score at follow-up (8.2) was similar to that prior to injury (8.3). IKDC overall results were normal in ten cases (55.6%), nearly normal in six cases (33.3%), and abnormal in two cases (11.1%). Side-to-side difference of anterior laxity measured with KT-1000 at 6 and 24 months did not show an impairment of knee stability with time. Isokinetic evaluation showed a significant improvement on peak torque both in extension and flexion on comparison between 6- and 24-month measurements. The results reported in this study showed that the use of doubled hamstring tendon graft for ACL reconstruction in athletes that were at risk for high-energy traumas to the knees, such as rugby players, gave normal or nearly normal results in about 90% of the cases. Recovery of muscle strength was almost complete 2 years after surgery, and there was no impairment of knee stability with time.

Vascular physiology and long-term healing of partial ligament tears

Functional outcomes of anterior cruciate ligament (ACL) injury are generally poorer than those of medial collateral ligament (MCL) tears. Following ligament damage, all phases of ligament healing require an adequate blood supply. We hypothesized that the differences in healing properties of the ACL and MCL would reflect their vascular responses to joint injury. This paper examines the long-term changes in blood flow and vascular volume of rabbit knee ligaments after direct injury, and under conditions of chronic joint instability induced by section of the posterior cruciate ligament (PCL). Standardized injuries were surgically induced in adult rabbit knee ligaments: partial MCL transection, partial ACL transection, or complete PCL transection (joint instability). Sixteen weeks later the blood flow and vascular volume of the ACL and MCL were measured and compared to control and sham-operated animals. Direct ligament injury induced significant increases in standardized blood flow and vascular volume of both ACL and MCL after 16 weeks; however, the vascular volume of the ACL was not higher than the control levels in the MCL. We conclude that direct injury to both the anterior cruciate and MCLs induces long-term physiological responses. Joint laxity is a common sequel to PCL injury. Chronic joint laxity failed to induce adaptive vascular responses in the ACL, while the MCL shows significant amplification of blood supply. Although both MCL and ACL showed increased weight after PCL transection, the lack of a long-term vascular response in the ACL may be a major factor in its the diminished healing potential.

Clinical evaluation of posterior cruciate ligament and posterolateral corner insufficiency

Injuries to the posterior cruciate ligament (PCL), and more commonly to the posterolateral corner (PLC), often gounrecognized. If present, posterolateral instability left untreated can compromise the results of anterior cruciate ligament or PCL reconstruction. Disruption of the PCL does not significantly increase internal or external tibial rotation. If increased external tibial rotation is present, there has been an injury to the PLC structures and the correction of the problem cannot be accomplished by cruciate ligament reconstruction alone. Appropriate recognition and treatment of posterolateal instability can restore normal rotatory motion patterns and can also reduce the stresses on cruciate ligament grafts, improving chances for successful results. The detection of posterolateral instability is best accomplished with the Dial test. PCL laxity is best detected by the posterior drawer test at 90° of knee flexion. Magnetic resonance imaging can be useful in delineating injuries to the PCL and PLC and is helpful in surgical planning. To document PCL and PLC laxity and to report the results of treatment, it is important to obtain stress radiography preoperatively for assessing posterior and varus instability and to record a Dial test to document posterolateral laxity.

Outcomes of anterior cruciate ligament reconstruction in patients with workers' compensation claims

A general perception exists that outcomes of orthopaedic procedures in patient's with Worker's Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examination revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1.9 mm with 15 patients (68%) having a maximum manual difference of ≤3 mm and 7 patients (32%) from 3 to 5 mm. The mean postoperative scores for the Hospital for Special Surgery scoring scale was 86, Noyes Sports activity scale 81, Noyes ADL score 36, Noyes Problem with Sports 75, Noyes Sports Function score 87, Lysholm score 82, and the Tegner score 5.9. The Noyes Occupational rating system increased from preoperative 48 to 60 postoperatively and the Noyes Job Title rating system score remained at 5 after surgery. Functional testing revealed mean deficits of no more than 9% between the reconstructed and normal knees. SF-36 testing revealed significantly higher scores in the Role Physical and General Health categories and significantly lower score in the Mental Health category when compared with United States norms. Subjective evaluation revealed that 95% of the patients would undergo a similar procedure if faced with a similar injury to the contralateral knee in the future. The results of the current study show that ACL reconstruction leads to predictable functional and occupational results in those patients with work-related injuries. All of our patients were able to return to work. The hypothesis that Workers' Compensation compromises the results of ACL reconstruction was not observed in this study.