Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Comparison of through-the-condyle and over-the-top graft placements.

Eighty-seven patients had anterior cruciate ligament reconstruction using one-limbed gracilis and semitendinosus tendon graft. No extraarticular or associated ligamentous procedures were performed. A 44-patient subgroup was alternated on an every-other-case basis between 2 graft placements, either over the top or through the femoral condyle; 64 patients (32 of each type) returned for complete evaluations. Average followup was 2.9 years. Groups were similar in age, gender, injury chronicity, number of meniscectomies, and preoperative activity levels. No statistical differences between groups were seen in overall knee rating, range of motion, KT-1000 arthrometer measurements, isokinetic muscle testing, or one-legged hop test. Injured minus normal anterior laxity at 89 N was 2.1 +/- 2.0 mm. Isokinetic testing demonstrated an average 95% normal knee extension strength and 106% normal flexion strength, measured at 60 deg/sec. Average hop index was 95%. Eight of 64 patients evaluated demonstrated injured minus normal differences of 4.5 mm or greater. Three of 8 had frankly positive 2+ and 5 had 1+ pivot shifts; however, 4 of these returned fully to sports, and 4 returned with modifications. Overall, 55 of 64 patients returned to preinjury sports.