Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency.

After diagnosing the anterior cruciate ligament (ACL) rupture by manual and arthroscopic examination with the patient under anesthesia, the decision to augment or substitute depends on the patient's requirements. In a community of athletically motivated patients, a method of strong, durable stabilization is achieved using a pedicled patellar tendon graft with a 90 degrees twist and bone-to-bone fixation. The intercondylar notch is surgically enlarged; holes are drilled from without into the tibia and femur, the graft is harvested with bone plugs at each end, pulled into place, and transfixed with screws. Knee function is tested before closure. After operation, the emphasis is on joint ranging exercises. Quadriceps exercises are not initiated until three months after operation. Participation in a sport is not advised for approximately one year. The patellar tendon graft has all of the advantages of an autologous tissue, either for augmentation or substitution of the ACL. It has strength, durability, and elasticity; it can be transplanted with bone plugs; with the infrapatellar fat pad preserved, it retains its paratendinous vascularity. The method has been employed for five years. No graft failures have occurred, and no patient has reinjured the reconstructed ligament. Not one patient has had to give up the sport that caused the injury due to recurrent instability.