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January 12, 1990

Several Choices Available for Repair of Ligamental Tears in the Knee

JAMA. 1990;263(2):197-201. doi:10.1001/jama.1990.03440020015005

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ONCE A TEAR is diagnosed, some surgeons still open the knee for repair, but the move is toward arthroscopic surgery, which has dramatically reduced the morbidity associated with knee surgery.

Most often, it appears, the orthopedic surgeon simply mends the tear in the ligament. But when it has failed completely, reconstruction or replacement of the ligament will be necessary.

The choices for repair include autografts, allografts, and prosthetic ligaments. Some surgeons have used the patellar tendon as a substitute for the anterior cruciate ligament.

Other graft choices include semitendinosus, gracilis, iliotibial band, fascia lata, and retinaculum.

Frank R. Noyes, MD, Cincinnati (Ohio) Sportsmedicine Center, prefers to use allografts of the anterior cruciate ligament. But he cautions they should be irradiated to guard against transmission of human immunodeficiency virus.

The key to successful surgery, Noyes says, is the placement of the graft at the ideal isometric point. "The most common mistake