We sought to determine prospectively the natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries in athletically active patients. The study population consisted of 133 patients (average age, 25.2 years at time of injury). All patients completed a subjective questionnaire each year for an average of 5.4 years (range, 2.3 to 11.4). Sixty-eight of the 133 patients returned to the clinic for long-term follow-up evaluation. Objectively, physical examination revealed no change in laxity from initial injury to follow-up. No correlation was found between radiographic joint space narrowing and grade of laxity. The mean modified Noyes knee score was 84.2 points, the mean Lysholm score was 83.4, and the mean Tegner activity score was 5.7. Patients with greater laxity did not have worse subjective scores. No correlation was found between subjective knee scores and time from injury. Regardless of the amount of laxity, half of the patients returned to the same sport at the same or higher level, one-third returned to the same sport at a lower level, and one-sixth did not return to the same sport. Results of this study suggest that athletically active patients with acute isolated posterior cruciate ligament tears treated nonoperatively achieved a level of objective and subjective knee function that was independent of the grade of laxity.

No abstract

A total of 60 children and adolescents with rupture of the anterior cruciate ligament (ACL) was seen between 1980 and 1990. Observation of the 23 patients who were treated conservatively revealed that the natural history of the injury resulted in severe instability and poor function of the knee. Associated meniscal tears were present in 15 knees. Three osteochondral fractures occurred and osteoarthritic changes developed in ten knees. In 1990 therefore we introduced reconstruction of the ACL with a four-strand hamstring graft using an anatomical placement with transphyseal tunnels and anchorage well away from the growth plate. Over a period of nine years, 47 knees underwent reconstruction. The mean follow-up was 49 months (12 to 96). No child suffered physeal damage or leg-length discrepancy. The results were satisfactory in 77% and there was little difference between patients treated before the adolescent growth spurt and those treated during or after this time. These results, however, were not as good as those seen in adults during the same period.

We report 72 patients with disabling knee arthrofibrosis who were treated at our clinic. All patients had painful restriction of extension or limitation of both extension and flexion that had persisted despite physical therapy. The level of arthrofibrosis was categorized into one of four types: Type 1 (25 patients), < 10 degree extension loss and normal flexion; Type 2 (16 patients), > 10 degree extension loss and normal flexion; Type 3 (15 patients), > 10 degree extension loss and > 25 degree flexion loss with a tight patella; and Type 4 (16 patients), > 10 degree extension loss, 30 degrees or more flexion loss, and patella infera with marked patellar tightness. All patients were treated with outpatient arthroscopic surgery. Anterior scar resection down to the proximal tibia was required for all patients with Types 2, 3, and 4 arthrofibrosis. Notchplasty was performed when necessary. Medial and lateral capsular releases and knee manipulation were required for patients with Type 3 or 4 arthrofibrosis. Postoperatively, all patients with Types 2, 3, and 4 arthrofibrosis were treated with outpatient serial extension casting. At the time of latest followup (28 to 115 months), the mean improvement of range of motion was as follows: Type 1, 7 degrees of extension; Type 2, 14 degrees of extension; Type 3, 13 degrees of extension and 28 degrees of flexion; and Type 4, 18 degrees of extension and 27 degrees of flexion. Improvement was also found for the mean stiffness, self-evaluation, functional activity, and Noyes knee scores in all groups.

A total of 60 children and adolescents with rupture of the anterior cruciate ligament (ACL) was seen between 1980 and 1990. Observation of the 23 patients who were treated conservatively revealed that the natural history of the injury resulted in severe instability and poor function of the knee. Associated meniscal tears were present in 15 knees. Three osteochondral fractures occurred and osteoarthritic changes developed in ten knees. In 1990 therefore we introduced reconstruction of the ACL with a four-strand hamstring graft using an anatomical placement with transphyseal tunnels and anchorage well away from the growth plate. Over a period of nine years, 47 knees underwent reconstruction. The mean follow-up was 49 months (12 to 96). No child suffered physeal damage or leg-length discrepancy. The results were satisfactory in 77% and there was little difference between patients treated before the adolescent growth spurt and those treated during or after this time. These results, however, were not as good as those seen in adults during the same period.