Anterior posterior laxities of the knee in chronic cases. Diagnosis, classification, simultaneous reconstruction of the two cruciate ligaments.

Chronic cases of combined rupture of the cruciate ligaments areexceptional and the surgical treatment is not codified. The reconstructionof the cruciates can be done classically in two stages usingtwo different types of autogenous tendon reconstruction.The first studies concerning the reconstruction of both cruciateligaments were those of Lipscomb and Anderson in 1990 andShapiro and Freedman in 1995 about acute cases arthroscopicallyoperated on with allograft tendons. Since 1996, six studies havebeen published in the literature concerning 44 chronic cases mixedwith 63 acute cases, but we found no retrospective or prospectivestudy concerning reconstruction of the two cruciates in chroniccases. Autografts and especially allografts had been used or bothand arthroscopy and surgical approach had been combined.A personal procedure was described in 1986 in Rev Chir Orthopand was used for 25 knees between 1983 and 2003, results are reportedfor the first time. This technique is designed for severechronic anterior posterior laxity of the knee often associated withcomplex peripheral laxity. There is a doubtless advantage in replacingthe entire central pivot with a single transplant inserted througha single access route, rather than combining several classical proceduresfor reconstruction of the cruciate ligaments using severalsimultaneous incisions.The examination of these knees confirmed that there was no ruptureof the two cruciates without important lesions of the peripheralligaments. Lateral laxity was important for 17 knees, medial laxityfor 15 knees and combined for 11 knees.Radiological precise measurements of the joint laxity in varus andvalgus, particularly the radiological anterior and posterior drawerusing a personal method permits us to elaborate a classification ofthese complex laxitiesThe reconstruction of the two cruciates has been associated withperipheral reconstructions according to the radiological laxity.Anatomical results have been measured. The mean gain for theanterior drawer was 5mm in the two compartments and for theposterior drawer the gain was 6 mm in the medial compartment and3 mm in the lateral compartment. Peripheral laxity was better corrected.Functional results at 5.8 years of follow-up were correct(except in 3 cases), with return to daily activities and work but fewreturn to sport activities and none of the knees were classified A inthe IKDC score.This technique should be reserved for exceptional cases, whereseverity of the laxity and major clinical instability make the use ofsticks or braces compulsory. Its advantages are a single simple access route and a single transplant which allow a brief period ofimmobilization and rapid rehabilitation.