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Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi
Tahoe Fracture and Orthopaedic Medical Clinic, South Lake Tahoe, California
From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomi tant extraarticular iliotibial band tenodesis. Twenty- seven knees (24 patients) were followed an average of 57.6 months postoperatively. Recreational skiing was resumed at 5.4 months on average, and in ski racing and pivot-requiring sports all but three patients re sumed participation at an average of 9.1 months. In 78% of the knees there was pain-free function. Mild pain was reported in 19%, the majority of which (4/5) was related to vigorous activity. Of the total, only two knees were reported to have a sensation of giving way.
On clinical examination 85% (23/27) had normal pivot shift examination with no evidence of abnormal motion. Four percent (1 /27) had a 1 + test and 11 % (3/27) had "glides." Arthrometer measurements revealed an aver age of 7.76 mm anterior displacement with 20 pounds of force on the knee with an ACL repair as compared to 5.56 mm on the uninjured knee. The laxity measure ments of knees with repaired ACLs fell within the range reported for uninjured knees in the normal population.
Five patients had reinjuries to the ACL at an average time of 28 months postoperatively, with two of five undergoing rerepair. Only one patient had an iliotibial band tenodesis to supplement the original ACL repair.
With proper surgical technique and rehabilitation, ACL repair can be statically and functionally successful in elite skiers. The use of the iliotibial band tenodesis is essential for successful ACL repair and the institution of immediate postoperative motion.
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