[Critical study of the repair of the anterior cruciate ligament of the knee using a pediculated flap to the Hoffa pad taken from the middle 3d of the patellar tendon. 50 surgical knees with a 2-to-4-year follow-up].

A reconstruction of the anterior cruciate ligament of the knee has been devised on the anatomical principle of an intra-articular flap taken from the middle third of the patellar tendon and based on the sub-patellar fat pad. Fifty knees have been treated and assessed after a follow-up of two to four years to provide a critical analysis of the method. The technique of the operation is described in detail in relation to the isometric reconstruction of the course of the anterior cruciate ligament. With a mean follow-up of 33 months (minimum 24 and maximum 48 months), 98 per cent of the patients had a good result as regards stability together with a good anatomical result, with complete or almost complete elimination of the anterior drawer sign and the jerk test in 96 per cent. The subjective result described by the patient was good in 92 per cent but only 54 per cent returned to the same sporting activity. The main problem encountered with this method was loss of 10 degrees of extension in 40 per cent of patients and loss of more than 10 degrees in 22 per cent. This loss of extension arose on the one hand from an impingement of the fatty pedicle in a narrow intercondylar notch and on the other from an associated postero-lateral laxity which resulted in an intra-articular transplant which was too short despite its anatomical attachments. The pedicled transplant has not given better results than free transplants and has given rise to additional iatrogenic problems even with a meticulous operative technique.(ABSTRACT TRUNCATED AT 250 WORDS)