ALTIIOGGII not a condition frequently met with in civil lifc, a not inconsidcrable number of cases of injury to the knee-joint associated with rupture or stretching of the anterior crucial ligament have come to notice since the War, mainly the.results of the violent strains of the joint to which the soldier on active service is exposed. Damage to the internal lateral ligament is invariably prcscnt. Refcrcnces t o the condition in literature are meagre ; records of results of treatment by the various methods which have been employed are scanty and lack conclusion.
A review of a series of cases in which reconstruction of the ligaments involvcd has bcen performed, and an endeavour made to follow up each case and examine the end-result, is put forward in this paper.
The series under consideration include eleven cases, all of which have been operated upon by Rfr. Alwyn Smith. Eight of these have been personally observed over periods varying from six months to three years. Information regarding the remaining three has been obtained by reference to their medical documents, the patients being War Pensioners, and by a written communication from each concerning what he himself felt regarding his condition and ability to work. As they were pensioners, a certain degree of caution in the replies was not unexpected.
The method adopted in all cases has been the modification of Hey Grovcs' opcrat.ion described by Mr. Alwyn Smith some years ag0.l Briefly, this consists in exposure of the joint through a J-shaped incision, the long arm running down the outer sicle of the thigh, passing below the tubercle of the tibia, and turning up over the inner aspect of the knee. The pateila is exposed, split vertically, and its halves are drawn apart. The external condyle of thc fcniur and internal tuberosity of the tibia are now drilled in the line of the anterior crucial ligament ; a strip of fascia lata 13 in. wide is then turned down from the thigh, and drawn through thc tunnel in the condyle and tibia1 tuberosity. The adductor tubercle is drilled subcortically, and the frce end of the fascia1 strip is passed up through this tunnel, turned down on itself, and sutured. In this manner replacement of the anterior crucial and internal lateral ligaments is sought.
The period elapsing between the receipt of injury and the date of operative treatment, in the series undcr consideration, varied from one to eight years. The conditions found at operation ranged from completc rupturc of both crucial, and tearing or stretching of both lateral, ligaments, as in Case 3, to stretching and atrophy of the anterior crucial ligament combined with INTERNAL LATERAL LIGAMENTS OF THE KNEE-JOINT.