Evaluation Of Surgical Treatment Of Old Anterior Cruciate Ligament Ingury:

Mohamed El-nady Ashour

197SUMMARYThe subject of this thesis is evaluation of thesurgical procedures in treatment of old anteriorcruciate ligament injury.We reviewed the anatomy of thebiomechanics and function of ACL,surgical treatment of old ACL injury.knee ligaments,diagnosis andThe ACL is a strong ligament about 41 cm long,connecting the anterior part of the intercondylarregion of the tibial plateau to the posterior part ofthe medial surface of lateral femoral condyle. It hassynovial covering which supplies it with its bloodsupply.The functions of the ACL is resistance of internalrotation, anterior translation, hyperextension of thetibia in relation to the femur.Diagnosis of old tear of the ACL is accomplishedby history of haemoarthrosis and pop during the initialinjury, recurrent giving way, pain and swelling.198Examination of ACL injury by the laxity tests canalmost reach the diagnosis. ArthroscopiC examinationcan be done to confirm the diagnosis and any internalderangement of the knee. Examination of associatedligamentous injury is essential part for the diagnosis.Reconstruction of ACL can be done either extraarticularusing mainly the ilio-tibial band or intraarticularusing the patellar tendon. the iliotibialband. the meniscus. the gracillis or the semitendonosustendon. The two procedures can be combined.We dealt with thirty-five cases with old ACLinjury. A thorough history for all of them was takenand preoperative of twenty six of them was recorded.Assessment of that material shows that thefrequency of giving is the major factor indetermination of the degree of the knee ins~ability.Extra-articular reconstruction of the ACL usingMacIntosh procedure was done for fifteen of them.Intra-articular reconstruction of the ACL usingmodified Jones procedure was done for the remainingtwenty cases. All of the cases were subjected to a199strict rehabilitation program ranging between threemonths for MacIntosh procedure and up to twelve monthsfor modified Jones’ procedure.The results of the cases were assessed accordingto patient’s opinion, subjective, functional andobjective criteria.The final assessment gave a(excellent and good) of:- MacIntosh procedure- Modified Jones’ proceduresatisfactory rating0.40.6After making a discussion of our results and theresults of other surgeons, we have found that modifiedJones procedure is the procedure of the future for oldtear of the ACL injury. Although this procedure carriesthe risk of complications but it provides better staticstability of the knee.