Long term results of late reconstruction for anterior or anteromedial instability of the knee.

Forty-one patients who had had surgical repair for anterior or anteromedial instability of the knee were examined on average 3.7 years after the operation. Of these patients, 17 had been injured in sports activities, 11 in work accidents, 5 in traffic accidents and 8 during other activities. Twenty-six patients underwent intra-articular reconstruction of the anterior cruciate ligament where the Jones procedure was used, 7 with the HeyGroves procedure, and 2 by the Eriksson procedure. The remaining 6 patients were treated by transfer of the gracilis, semitendinosus tendon or fascia lata. During the operation, the medial collateral ligament was reefed in 4 knees and Mauck's reconstruction was performed on 4 knees. Medial meniscectomy was carried out in 9 patients. The results were evaluated using subjective, functional and objective criteria. The objective criteria included both clinical examination and stress radiography using a specially designed apparatus. Laxity of the medial collateral ligament and anterior drawer sign were recorded on radiographs, using the uninjured knee for comparison. The operation was estimated to have been successful subjectively (excellent or good) in 25 patients, functionally successful in 20 and objectively successful in 23 patients. In the personal opinion of 33 patients the knee improved. Meniscectomy and long follow-up time were found to cause a decrease in successful results. More arthritic changes appeared if meniscectomy had been performed. The patients returned to work within an average period of 3.7 months. In 7 cases the result was classified as functionally poor, and the knee required a subsequent operation.