Failure of clinical methods in assessing graft integrity after anterior cruciate ligament reconstruction: an arthroscopic evaluation.

We reviewed the findings of 24 patients who underwent knee arthroscopy following a bone-patellar tendon-bone autograft anterior cruciate ligament (ACL) reconstruction. Preoperative symptoms included pain, swelling, catching, and/or locking. Only one patient presented with subjective instability. The subjective and objective clinical findings as well as KT-1000 examination were compared with the arthroscopic findings. Thirteen of the 24 patients had an insufficient ACL graft by arthroscopic examination. In only 5 of these patients did the physical examination and/or KT-1000 results reliably detect an insufficient ACL graft. The remaining 8 patients had a stable knee by subjective and objective clinical criteria as well as strict KT-1000 criteria. No significant degenerative changes or lack of motion was present in this group. Also, 7 of the 8 patients had an excellent or good Orthopädische Arbeitsgruppe Knie (OAK) score and maintained a high level of function. In the two patients who underwent preoperative magnetic resonance imaging the lack of an intact graft was confirmed. A subset of patients appear to have stable knees despite the lack of a functioning ACL graft. Therefore, standard clinical and KT-1000 criteria for ACL deficient knees have limitations in detecting graft integrity after ACL reconstruction. Arthroscopy or magnetic resonance imaging may be needed when graft integrity is in question.