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First published on October 11, 2007, doi:10.1177/0363546507307501
This version was published on February 1, 2008
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The American Journal of Sports Medicine 36:333-339 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

Isolated Anterior Cruciate Ligament Reconstruction in Patients With Chronic Anterior Cruciate Ligament Insufficiency Combined With Grade II Valgus Laxity

Kenji Hara, MD{dagger},{ddagger},*, Sadao Niga, MD, PhD{dagger}, Hiroo Ikeda, MD{dagger}, Sadahiro Cho, MD, PhD{dagger} and Takeshi Muneta, MD, PhD{ddagger}

From the {dagger} Department of Orthopaedic Surgery, Kawaguchi Kohgyo General Hospital, Kawaguchi, Japan, and {ddagger} Section of Orthopaedic Surgery, Division of Bio-Matrix, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

* Address correspondence to Kenji Hara, MD, Section of Orthopaedic Surgery, Division of Bio-Matrix, Graduate School, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan (e-mail: k-hara.orth{at}tmd.ac.jp).

Background: There is no consensus about whether isolated anterior cruciate ligament reconstruction using multistrand hamstring tendon with nonoperative treatment for chronic medial collateral ligament injury is sufficient.

Purpose: To assess clinical outcome for patients with chronic anterior cruciate ligament injury and accompanying grade II valgus laxity who received medial hamstring anterior cruciate ligament reconstruction alone. Results were compared with those of patients with isolated chronic anterior cruciate ligament injury without valgus laxity.

Study Design: Cohort study; Level of evidence, 2.

Methods: Two hundred eighty-nine patients with isolated anterior cruciate ligament injury were compared with 53 patients with accompanying valgus laxity (minimum follow-up, 24 months). The following parameters were compared between the 2 groups at the last follow-up: range of motion, KT-1000 arthrometer value, pivot-shift test result, Lysholm knee scale, knee extensor muscle strength, return to sporting activities, subjective recovery, and International Knee Documentation Committee grade. Differences in clinical outcome were evaluated between those with preoperative International Knee Documentation Committee grade B and grade C and between those with grade A and grade B or C at final evaluation.

Results: Postoperative KT-1000 arthrometer value averaged 1.2 mm for those with isolated anterior cruciate ligament injury and 1.6 mm for those with accompanying valgus laxity (not significant, P = .281). There was no significant difference between these 2 groups regarding the other items. In patients with preoperative valgus laxity, KT-1000 arthrometer values at final evaluation between patients with preoperative grade B and C were not significantly different. The value for subjects with grade A at final evaluation was 1.3 mm and for those with grade B or C at final evaluation was 2.7 mm (P = .065).

Conclusion: There was no clinically significant difference regarding outcome of anterior cruciate ligament multistrand hamstring reconstruction alone for 90% of patients with grade II valgus laxity who regained medial stability with nonoperative management compared with those who underwent the same anterior cruciate ligament reconstruction for an isolated anterior cruciate ligament tear.

Key Words: anterior cruciate ligament (ACL) injury • combined medial collateral ligament (MCL) injury • chronic injured knee • isolated ACL reconstruction






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