RESULTS OF MACINTOSH QUADRICEPS PLASTY REINFORCED WITH THE FASCIAL LATA FOR MAJOR ANTERIOR LAXITY OF THE KNEE: 108 CASES

Abstract

Purpose: The aim of this work was to evaluate functional and anatomic results of MacIntosh quadriceps plasty reinforced with a free fascia lata transplant used for the treatment of severe anterior laxity of the knee.

Material and methods: We considered severe laxity to be defined as a differential greater than 10 mm (manual Lachmann maximum on KT1000) compared with the healthy side and/or an explosive pivot test scored +++ and/or absolute laxity measured at 20 mm. This retrospective series included 108 patients treated between 1995 and 1998 by the same operator (DS). There were 70 men and 38 women, mean age 29±8.7 years (15–52). Average time from trauma to treatment was 38 months (2–324). Among the 98 patients practicing sports, 47 (43.5%) practiced pivot sports with contact and 51 (47.2%) practiced pivot sports without contact. Mean preoperatiove laxity KT1000 was 18±3 mm (13–30) on the diseased side and 5.34±1.9 mm on the healthy side (15 knees excluded due to rupture of the contralateral anterior cruciate ligament). Mean differential laxity was 12.6±2.3 mm (9–21) and in 44 patients (40.8%) the pivot test was scored +++. Only 37 knees (34%) were totally free of meniscal lesions. Outcome was evaluated by an independent operator using the IKDC method.

Results: Results were analysed for 71 patients (37 lost to follow-up giving a review rate of 65.8%) with a mean follow-up of 63.4±12.9 months (40–86). Absolute postoperative laxity was 8.9±2.9 mm (2–18) and differential laxity was 2.6±2.3 (−2 to +8) giving a mean gain in laxity of 10 mm. The pivot test was negative in 73.2% of the knees, 22% were scored +, and 4.2% ++. The overall IKDC score was 87.3±9.6 (56–100). 90% of the patients were satisfied or very satisfied with outcome. Furthermore, 80.3% of patients were able to resume their sports activities at the same or higher level.

Conclusion: Mixed plasty using the MacIntosh method with lateral reinforcement using the fascia lata enables effective treatment of severe anterior laxity of the knee. Few studies have differentiated laxity according to severity. Prospective randomised studies devoted to patients with very severe laxity are needed to confirm the results of this technique in comparison with isolated plasty of the anterior cruciate ligament without lateral reinforcement.