Augmentation with the longitudinal patellar retinaculum in the repair of an anterior cruciate ligament rupture

Abstract

Most authors advocate repair of the acutely ruptured ACL by augmentation or some form of primary recon struction. Strong autogenous tissues like the patellar and semitendinosus tendons and the iliotibial band are often used when augmentation is the surgical choice. This paper describes a surgical procedure using a strip of the longitudinal patellar retinaculum as an aug mentation of the repaired ACL. The retinaculum adds stability and strength to the repaired ACL during the healing period. Moreover, the retinaculum may enhance the healing process of the ruptured ACL by revascular ization. It may also increase the stimulation of synovial tissue proliferation over the repaired ACL. Twenty-eight patients have been clinically and objec tively evaluated at a mean follow-up time of 78 months (range, 63 to 94 months). The patients' own evaluation of their knee function was excellent or good in 86% (24 patients). Eighty-two percent (23 patients) could return to their preinjury activities at the same intensity level as before injury, whereas at an intermediate followup at 18 months only 64% (18 patients) had done so. Anterior tibial displacement was objectively evaluated at both followups by means of the anterior drawer test, with 20° to 30° and 90° of knee flexion, in a testing device. The operated knee usually showed a tendency to a slightly increased anterior displacement when com pared with the uninjured knee. The repair of a ruptured ACL with an augmentation using the longitudinal patellar retinaculum has been shown to give good results after more than 5 years.