Long-term outcome of MacIntosh reconstruction of chronic anterior cruciate ligament insufficiency using fascia lata

The purpose of this study was to assess the long-term outcome of the MacIntosh lateral-substitution over-the-top anterior cruciate ligament (ACL) reconstruction in 82 patients (84 knees) at an average follow-up of 9.8 years. In this retrospective cohort study patients were evaluated with subjective questionnaires and by clinical and radiographic examination. Using the Lysholm score, 17 knees were rated excellent, 35 good, 19 fair, and 13 poor. The pivot shift test was negative in 74 patients. Altogether, 30 knee radiographs were evaluated. The mean Hospital for Special Surgery ACL radiographic score was 20.9. There was a non-significant association between the radiographic score and the Lysholm score and between a worsening radiographic score and increasing time from injury. The MacIntosh lateral-substitution over-the-top ACL reconstruction shows results comparable to those of previously reported long-term studies. Although endoscopically assisted intraarticular reconstructions with faster rehabilitation protocols have now become popular, this procedure may be considered in patients needing an intra- and extraarticular reconstruction in whom cosmesis is not an issue.