We have evaluated 15 patients after replacement of a ruptured anterior cruciate ligament with a free graft of the medial third of the patellar tendon, combined with a MacIntosh lateral tenodesis. The results were excellent or good in all cases, and 12 of the patients were able to return to their original athletic activity. The technique of operation for free graft using the patellar tendon is described in detail.
There have been many reports about problems in obtaining ligamentous isometricity using the over-the-top method, but this method is much more easier to perform than making a drill hole in the ideal position on the lateral femoral condyle.
In our opinion, technical factors are often responsible for this reported difficulty, and certain aspects of the operation technique deserve emphasis.
