Treatment of the Cruciate Deficient Degenerative Knee

David P Johnson and M Mansfield

Increasingly we are presented with a young 30 - 50 year old adult with early articular degeneration resulting from a chronic anterior cruciate ligament deficiency, articular damage and menisectimy. An analysis was undertaken of six such patients two years after undergoing a procedure which combined a lateral excision wedge high tibial osteotomy fixed with a lateral staple was combined with an extra-articular anterior cruciate biceps tendon tenodesis between the anterior aspect of the fibular head and the isometric point on the lateral aspect of the femoral condyle.

No peri-operative complications occured. Hospitalisation was for three days. Immobilisation was for six weeks in a plaster cast. Union of the osteotomy occurred in all cases, and a full range of motion was obtained by three months. At two year review, all patients had significantly improved function from their knee, the Tegner activity score increased from 4.2 to 5.8 (p<0.01) and 50% had returned to some sporting activities. Two of the 6 patients were completely pain free, four experienced mild activity related pain. All patients had lost their symptomatic knee instability, and wore no external support. As perhaps expected, objective clinical evidence of anterior cruciate laxity was present in all the knees.

Though excellent subjective results can be expected at two years from this new procedure, the extra-articular tenodesis objectively stretches with time, even in this intermediate activity population. Further efforts will be undertaken to combine the high tibial osteotomy with a more lasting intra-articular anterior cruciate reconstruction.

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