Anterior cruciate reconstruction using the MacIntosh lateral-substitution over-the-top repair.

We reviewed the results of a MacIntosh lateral-substitution over-the-top repair for chronic anterior cruciate-ligament insufficiency in thirty-four patients. This technique is a combined intra-articular and extra-articular repair using a strip of the tensor fasciae latae that is based at Gerdy's tubercle. We describe the operative procedure in detail. The patients were evaluated for both subjective and objective improvement. The average length of follow-up was thirty-seven months (range, twenty-four to fifty-nine months). Thirty-one patients (91 per cent) had a good or excellent result and in three patients (9 per cent) the result was rated as a failure. Ninety-seven per cent returned to their preoperative level of activity. There were no significant complications. We recommend this repair as a sound and effective method of treating chronic anterior cruciate-ligament insufficiency in the young to middle-aged symptomatic patient.