Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract.

We are reporting the results of a reconstructive procedure designed to decrease anterior tibial subluxation due to disruption of the anterior cruciate ligament. The operation combines both intra-articular and extra-articular methods. The semitendinosus tendon and the iliotibial tract are both routed from opposite directions over the top of the lateral femoral condyle and through the same oblique drill-hole in the proximal part of the tibia: the semitendinosus tendon is passed up through the tibial drill-hole, across the knee joint, over the top of the lateral femoral condyle, and deep to the fibular collateral ligament, and the iliotibial tract is passed deep to the fibular collateral ligament, over the top of the lateral femoral condyle, across the knee joint, and down through the drill-hole. Both grafts are simultaneously pulled tight while the semitendinosus tendon is sutured to the iliotibial tract laterally and the iliotibial tract is sutured to the semitendinosus tendon medially below the drill-hole. The posteromedial and lateral parts of the capsule are advanced to tighten the secondary restraints. One hundred of the first 106 consecutive patients with chronic instability who had this procedure were evaluated using subjective and objective criteria at three to seven and one-half years after surgery. The positive anterior-drawer sign tested at 25 degrees of flexion was eliminated or reduced to 1+ in eighty knees, and the positive pivot shift was reduced to zero or 1+ in ninety-one knees. The objective assessment of isokinetic muscle performance and passive tibial rotation showed significant improvements in strength and normalization of tibial rotation.