Abstract des Autors

A prospective study of a population of 23 patients with bilateral ACL insufficiency treated by means of contemporaneous surgery in the period February 1988 to March 1991 is presented. The diagnosis was easy, whereas the treatment is a subject for comparison owing to the peculiarity of the situation. Two solutions were adopted on the basis of precise and agreed indications, and to reach different objectives. Meniscal and/or cartilaginous arthroscopic surgery without ACL reconstruction was carried out in 13 cases, whereas free patellar tendon reconstruction was performed in the other 10. The rehabilitation programme was similar to that adopted for the corresponding unilateral operation during the same period. Perioperative morbidity was higher than in unilateral surgery, but significantly lower than for the same operations performed consecutively. Resumption of work and physical activity times were 25% longer than after a unilateral operation, whereas the short and medium-term results were similar. Since in 90% of cases rupture of the two ACL took place at successive times, and since the first rupture was not correctly diagnosed, stress is laid on the need for sure diagnosis to prevent not only meniscal and cartilaginous involvement, but also the second ACL tear. In the presence of bilateral ACL insufficiency, the problem of the therapeutical indications is still more delicate than for the unilateral form. If the programme is surgical, arthroscopic assistance and accelerated rehabilitation protocols permit the simultaneous undertaking not only of minimal but also of reconstructive surgery, with results similar to the corresponding unilateral interventions, and considerable abbreviation of the times compared with non-simultaneous bilateral operations. Verf.-Referat