Anterior cruciate ligament arthroplasty.

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes anserine transfers. This coincided with a proposed pathologic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate stabilizations arthroplasties were performed. Patients with less than a 2 year followup were not included in this retrospective study. One hundred nine arthroplasties are reported: 80 isolated ACL tears and 29 multiple ligament injuries. Statistically significant relationships between elapsed time from ACL tear to surgery and meniscal tears, and elapsed time and degenerative changes in the articular surfaces were seen. Surgical technique was arthroplasty, graft harvest, graft placement, graft set, and postoperative care. Functional score followup has occurred for an average of 3 years (range 2 to 5 years). No patient has failed to return to his or her original sport or occupational demands. Pivot shift, disengagement, or spontaneous rupture of the arthroplasty has not occurred postoperatively. Full participation has occurred with bilateral ACL arthroplasties and arthroplasty performed for previous intraarticular augmentation failure. The operative success in the preliminary follow-up period was based on: ligamentous substitution, anatomical placement, femoral intercondylar notch compliance in full range of motion, revascularization of the ligament substitute, and histologic support of the procedure.