Anterior cruciate ligament insufficiency treated by combined medial and lateral extra-articular reconstruction.

Thirty patients who required surgery for an unstable knee with "giving way" symptoms were operated during 1979-1981 with a pes anserinus transfer and an Ellison procedure at the same séance. All patients had an insufficient anterior cruciate ligament prior to surgery. Of these 24 patients had a positive pivot-shift test, and 26 patients had an anteromedial rotatory instability. Twenty-eight patients were seen at a follow-up after an average of 28 months (range 19-49). There were 12 women and 16 men, with a mean age of 28 years. Eleven patients (39%) declared that their knee function was distinctly improved, and six (21%) that it was moderately improved after surgery. Knee function was unchanged for ten patients (36%), and one patient said that the knee function had deteriorated after surgery. The functional result was not correlated with the duration of symptoms or with the follow-up time. Physical examination revealed that the anterior drawer had not disappeared for any of the patients. A positive pivot-shift sign was still present in 18 patients, and 23 patients displayed an increased varus instability.--All but six patients still had some instability experiences, and most of them could not completely return to active sports. However, the method could provide an alternative for patients engaged in frequent but not heavy physical activity.