Les auteurs ont évalué au recul moyen de 5,2 ans une série continue de 50 patients sportifs en pivots réparés dans les 8 premiers jours d'une rupture isolée du LCA selon la technique de MacIntosh modifiée utilisant le tractus iliotibial. La section de la cloison intermusculaire latérale a permis une reconstitution du hauban latéral tout en prélevant une bandelette de 40 à 45 mm de largeur. Les résultats globaux selon la fiche de cotation IKDC ont été comparables à ceux d'autres auto-transplants : 38 % (IKDC A), 46 % (B), 12 % (C), 4 % (D). La laxité résiduelle différentielle moyenne a été mesurée à l'arthromètre KT-1000 à 1,86±1,74 mm. Quarante-huit pour cent des genoux ne présentaient pas de signe de Lachman. Les ressauts ont été neutralisés dans 88 % des cas. Selon les critères de la fiche de cotation Arpege, nous avons observé 38 % de résultats excellents, 46 % de bons résultats, 12 % de résultats moyens et 4 % de mauvais résultats. Trente-trois patients sur 50 ont conservé au recul le même niveau d'activité sportive. Un échec anatomique précoce et deux cas de ruptures itératives traumatiques sont survenus à 25 et 38 mois de recul. Deux flexum irréductibles de plus de +5° et trois déficits en flexion supérieurs à 20° ont altéré les résultats fonctionnels. Une compétitrice ayant pu reprendre ses activités sportives a eu une mobilisation de son genou sous anesthésie générale. Un seul cas de hernie musculaire par déhiscence a été observé au niveau de la zone prélevée. Le déficit résiduel moyen quadricipital a été à 12 mois de 10 % à 90°/s et celui des ischio-jambiers de 1,3 % à la même vitesse.

Comparisons have been often made between bone-tendon-bone plasty and hamstring tendon four-strand plasty. Whether a lateral tenodesis should be associated with the intra-articular reconstruction and the appropriate time between the accident and the repair remain two topics of debate. We present results obtained in a consecutive series of 50 pivoting sport atheletes reviewed retrospectively. These patients had been treated within eight days of trauma with a modified MacIntosh technique using an iliotibial band. This technique enables lateral tenodesis and reconstruction of the central pivot with only one harvesting site. We searched for responses to two questions: are our results comparable to those in other published series? could this operation be warranted as an emergency procedure?

Fifty patients from a consecutive retrospective series of 62 patients (eight lost to follow-up and four excluded from the analysis) were reviewed by an independent observer at mean follow-up of 5.2 years (range 54.4 to 86.4 months). The ARPEGE and IKDC scoring systems were used. An isokinetic assessment was obtained in 38 patients at one year. The reconstruction technique used an iliotibial band measuring 40-45 mm in width. The lateral reconstruction consisted in section then translation of the lateral intermuscular partition.

The overall outcome was scored as follows: IKDC A 38%, B 46%, C 12%, D 4%. Mean residual differential laxity (KT 1000) was 1.86±1.74 assessed manually with a negative Lachman in 48% of knees. 88% of the positive tests had been neutralized. Early anatomic failure was noted in two knees with recurrent traumatic tears at 25 and 38 months. Using the ARPEGE scoring system, outcome was excellent in 38%, good in 46%, fair in 12% and poor in 4%. At last follow-up, the level of sports activities was unchanged in 33 patients. Irreducible flexion measuring more than 5° was noted in two patients, and a deficit in flexion greater than 20° in three. One female athlete who had resumed her former sports level presented mobilization under narcosis. None of the patients complained of pain at the harvesting site. There was one case of muscle herniation proximally by wound dehiscence. Mean residual deficit of the quadriceps, measured at twelve months, was 10% at 90°/s; mean residual deficit of the hamstrings at the same speed was 1.3%.

Our overall results as measured with the IKDC scoring system were comparable with those observed in series using other autologous transplants. The risk of stiffness is greater with early reconstruction, suggesting emergency repair should be considered with caution. Recovery of muscle force demonstrates one of the advantages of using the iliotibial band which does not injure the extensor-flexor system of the knee joint. The fact that none of the patients complained of pain at the harvesting site is a favorable element for rehabilitation and resumed sports activities.