[Arthroscopic treatment of the unstable knee joint by ligament reconstruction using allografts].

PURPOSE OF THE STUDY: Recurring and multidirectional instability of the knee joint is a therapeutic problem mainly due to a limited possibility of harvesting grafts for its treatment. The authors present the methodology of the solution of recurring and multidirectional instabilities of the knee joint by means of allografts. They inform about the technique of harvesting and preservation of grafts and include the necessary examinations and early results.

MATERIAL: Due to the above mentioned reasons the authors concentrated on the possibility of harvesting grafts for ligamentoplasty from donors. They developed the technique of harvesting, examination and preservation of allografts and their application by arthroscopy both in recurring and multidirectional instability. They used grafts from lig. patellae and m. quadriceps femoris. In the group of 21 patients operated on they used allograft for ligamentoplasty of 15 anterior cruciate ligaments (ACL) and 9 posterior cruciate ligaments (PCL), (4 times multidirectional instability of ACL + PCL, 14 times patellar tendon and 10 times tendon of m. quadriceps femoris).

METHODS: Harvesting of grafts for ligamentoplasty from donors, examination according to EATB rules, preservation at the temperature of -80 degrees C. Prior to the application an antibiotic bath for 10 minutes. Application of grafts by arthroscopy, for ACL the grafts were used from patellar tendon and m. quadriceps femoris, for PCL the grafts from m. quadriceps femoris anchored in two channels. Operation in multidirectional instabilities in one step procedure--ACL, PCL and posterolateral capsular complex. Fixation by orthesis for 6-8 weeks according to the type of operation, early physiotherapy starting from 2nd day after operation.

RESULTS: No differences were found in the postoperative course (immune or any other reaction) in comparison with autografts (duration of hospitalization, postoperative regime, pain), physiotherapy in the replacement of one ligament is faster in comparison with autografts. Ingrowth of allografts according to radiographs is without any special reaction. Results were evaluated according to Lysholm score and they show a significant improvement as compared to the condition prior to operation. No peroperative and postoperative complications were found. There was no immune reaction after the operation, in all patients there occurred a significant improvement of the stability of the knee joint. The results according to Lysholm score prior to the operation and after the ligamentoplasty show both a subjective and objective improvement after the operation.

DISCUSSION: Application of allografts for the reconstruction of recurring and multidirectional instability of the knee joint is a method offering new possibilities. Its advantages include reduction of the duration of surgery, significantly reduced morbidity of the joint operated on, the possibility of adjustment of the graft, if need be. Disadvantages are the following: the possibility of a transfer of a virus disease which can be eliminated by a careful examination of donors; a longer period of graft remodelling, which can be compensated by a correct physiotherapy and postoperative regime.

CONCLUSION: Application of allografts in the surgical treatment of instability of the knee joint is suitable in the current period of well developed examinations and surgical techniques. Early results are optimistic. Observation of all rules for the application of allografts will allow to extend in the correct indications the range of the possibilities of surgical treatment of recurring and multidirectional instabilities of the knee joint.