TECHNIQUE OF ANTERIOR CRUCIATELIGAMENT RECONSTRUCTION USINGPES ANSERINUS TENDONS
A. Michallon University Hospital - Grenoble, France
A number of techniques have been found to work well inthe reconstruction of a torn anterior cruciate ligament(ACL). We agree with JY Dupont that the chief outcomecriterion in the long term is an anatomical one, with"complete restoration of the knee joint." However, inaddition to the modified Marshall-MacIntosh and similartechniques for ACL reconstruction, which are known toprovide long-term stability, several arthroscopictechniques have been developed, which have thebenefit of being minimally invasive and of causing lessiatrogenic damage. This, obviously, is a majorconsideration in ACL surgery. With the development of these techniques, the choice of graft harvesting site hasalso become an important factor. It should be borne inmind that, in many athletes, the patellofemoral painfollowing graft harvesting from the extensor mechanismwill rule out a return to sports at the previous level.Using the pes anserinus as a donor site appears to be asafer alternative. While the long-term stability outcomeof semitendinosus-gracilis (STG) grafts is not yet fullyknown, there is a current trend to use these pestendons. With the advent of better arthroscopic aimingand graft fixation systems, an increasing proportion of the ACL reconstruction "market" is being catered for bySTG grafts. However, there are pes tendon grafts andpes tendon grafts, as may be seen from the history of the use of these tendons in ACL reconstruction surgery(P Colombet). The 1999 Symposium of the FrenchSociety for Arthroscopy also stressed the fact that themany ways in which pes tendon grafts may beperformed make it difficult to assess the value of theconcept in a multicentre study. In the interest of evaluation, ACL reconstruction with pes anserinustendons should be performed following certain rules.