Corrective surgery for anterior cruciate ligament (ACL) lesions was performed in 64 patients. Approximately two-thirds of the patients who presented with anteromedial instability were approached through the medial aspect of the knee. In all cases the instability was improved but not entirely eliminated. This was not in itself a disabling problem, as 44% of these patients had good subjective results. However, pivot-shift tests at follow-up examination clearly indicated the presence of anterolateral instability in most, if not all, of these patients. This did not necessarily preclude a self-evaluation of “good”; conversely, a self-evaluation of “fair” (33% of patients) was always related to a positive pivot-shift phenomenon. The authors' current surgical policy is, therefore, to regard the two types of instability as related aspects of a single ACL insufficiency syndrome, and to correct both the anterolateral instability (by the Macintosh procedure) and the anteromedial instability (by suturing the posterior medial capsule to the semimembranosus tendon together with pes transfer). Poor subjective results (22% of patients) were always associated with the patellofemoral pain syndrome, which could be traced to rotational instability leading to patellar malalignment.
Department of Orthopedic Surgery, Assaf Harofeh Hospital, affiliated with the Sackler School of Medicine, Tel-Aviv University, Zerifin, Israel.