ABSTRACTS

Fresh intraligamentous injuries of the posterior cruciate ligament (PCL) in four patients and of the anterior cruciate ligament (ACL) in another four pa- tients were allowed to heal without surgery, but with early mobilization to stimulate the injured col- lagen fibers to reform stress-oriented fibers. All pa- tients were examined arthroscopically and we tried to reposition the ruptured fibers of the ligament ex- trasynovially on the seventh day, on the average, following injury. Dynamic joint control training be- gan immediately after arthroscopy. The knees were mobilized on day four on the average, after arthros- copy with use of a Kyuro knee brace with a double- traction system to cause physiological stress but to avoid excessive stress of the injured ligament. Par- tial weight bearing was allowed on day 22, on the average, and full weight bearing was allowed after an additional 2-3 weeks. Arthroscopy and roent- genograms with A-P stress were reexamined after five weeks for PCL injuries and after 3 months for ACL injuries.

PCL injuries were monitored for a mean of 6.5 months. On stress x-ray films with posterior strain, one case improved greatly and slightly in two cases, with no change in one case with slight posterior drawer at injury. On the second arthroscopy, the fibers of the PCL protruded intrasynovially and looked like scar tissue. However, the tension and volume of the PCL were good in two cases, and decreased in two cases, one in which the tension was poor. One patient could resume full activities as a baseball player in 5 months.

ACL injuries were monitored for a mean of 4.3 months. Stress x-rays with the Lachman test was improved greatly in two cases, fairly in one case, and slightly in one case in which the Lachman test was slightly positive at injury. On the second ar- throscopy, the ligament was less soft than normal, however. Blood circulation of the ACL was good. The tension of the ACL was strong enough in three cases and had decreased slightly in one case.

Fresh ruptures of the cruciate ligaments seemed to be treatable without operation nor immo- bilization, but we recommend early mobilization with a knee brace with a double-traction system within the limits of physiological stress.

Arthroscopic Reconstruction of the Anterior Cruciate Ligament. Kaku Shiraoka, Taiho Shibata, Nobuo Takubo, Yoshiro Matsuda, Takashi Suto, and Kenji Kariyama. Ehime, Japan.

Arthroscopy, Vol. 7, No. 4, 1991

The success of anterior cruciate reconstruction depends on accurate assessment of the patient and correct diagnosis. An objective means of classilica- tion of instability in the knee deficient in the ante- rior cruciate ligament has not yet been described. Here, we studied associated injuries of the menisci, capsular structures, and articular cartilage by use of radiography, stress films, arthrography, and intra- operative arthroscopy.

Since March 1986, we have arthroscopically re- constructed the anterior cruciate ligament with a Leeds-Keio artificial ligament in 55 patients (55 knees). There were 33 men and 22 women with a mean age of 26 years (range, 16-52). The mean length of time from injury to reconstruction was 29.4 months (4 months to 5 years). Fifty-three of 55 patients also had associated injuries: meniscal inju- ries in 47 knees (medial menisci in 37 knees, lateral ones in 23 knees), extraarticular capsular ligamen- tous injuries in 28 knees (medial side in 19 knees, lateral side in 9 knees), and articular cartilage dam- age in 14 knees.

Isolated intraarticular reconstruction was per- formed in 29 knees. In the remaining 26 knees, an abnormal opening of the femorotibial joint space was found under intraoperative arthroscopic con- trol after intraarticular reconstruction, combined in- traarticular and extraarticular procedures were per- formed. The extraarticular procedures consisted of medial augmentation in 18 knees and lateral aug- mentation in 8 knees. Arthroscopic evaluation be- fore and after intraarticular reconstruction was use- ful to decide indications for extraarticular surgery.

Arthroscopic Study of Meniscal and Chondral Lesions in Anterior Cruciate Ligament-Deficient Knees. Kenji Kubota, Hiroshi Mizuta, Kouichi Kai, Mi- noru Shiraishi, Katsuhiko Sakuma, Noriyoshi Na- gamoto, and Katsumasa Takagi. Kumamoto, Ja- pan.

We studied arthroscopically the meniscal lesions and chondral lesions of the femoral condyle of 83 anterior cruciate-deficient knees in 80 patients. The mean age of the patients at the time of arthroscopic examination was 22.0 years (range, 12-39), patients 340 were excluded. We classified the knees accord- ing to the time from the initial injury to arthroscopic examination; for Group I (35 knees), this was less than 1 month; for Group II (20 knees), 1 month to 1 year; for Group III (12 knees), l-3 years; and for Group IV (16 knees), >3 years.