Diagnosis and Macintosh substitution for chronic anterior cruciate insufficiency.

Of 45 consecutive knees undergoing MacIntosh fascia lata anterior cruciate substitution, only five had accompanying collateral ligament laxity. Over a third of cases (16) had more than ten episodes of major instability causing falls to the ground pre-operatively. The initial injury caused haemarthrosis, usually without external trauma (36), was often accompanied by a sensation of knee disruption (18), and was always associated with immediate disability. The results of 26 lateral substitution operations with minimum 12 month follow-up show abolition of pivot shift jerk in all patients. Incomplete control of objective and functional instability postoperatively in four patients may have been related to soft tissue stretching associated with early mobilization in a cast-brace or generalized ligamentous laxity.