Arthroscopic Anterior Cruciate Ligament Reconstruction Using Fresh-Frozen Bone Plug–Free Allogeneic Tendons: 10-Year Follow-up Ken Nakata, M.D., Ph.D., Konsei Shino, M.D., Ph.D., Shuji Horibe, M.D., Ph.D., Yoshinari Tanaka, M.D., Ph.D., Yukiyoshi Toritsuka, M.D., Ph.D., Norimasa Nakamura, M.D., Ph.D., Maki Koyanagi, R.P.T., M.S., and Hideki Yoshikawa, M.D., Ph.D. Purpose: To evaluate the long-term outcomes following arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction using fresh-frozen allogeneic tendon. Methods: Sixty-one athletically active patients (mean age at surgery, 20.9 years) who had arthroscopic-assisted ACL reconstruction using fresh-frozen free tendon allograft underwent physical examination, instrumented laxity mea- surement, radiographs, and thigh muscle strength at 10 to 14 years (mean, 11.5) postoperatively, and these data were compared with results of similar measurements obtained at 2 years postoperatively. Results: Lachman test and pivot shift test were maintained as negative in 53 (87%) and 52 (85%) patients at follow-up, respectively. Quantitative measurements using the KT-2000 knee arthrometer showed 1.6  1.3 (mean  SD) mm in the side-to-side difference, and no more than 3 mm in 56 patients (92%) at final follow-up. All but one was assessed as normal or nearly normal by International Knee Documentation Committee score. Patient activity level was decreased at the long-term follow-up, but this change was mainly associated with changes in social context (e.g., graduation from school) rather than with knee limitations. None of the patients experienced deep infection or graft rejection. Degenerative joint disease on radiographs was seen in 13 out of 15 patients (87%) whose menisci had been excised, whereas it was observed in 12 out of 46 ( 26%) whose menisci had been preserved. Conclusions: A series of 61 patients with fresh-frozen bone plug–free tendon allografts using a 2-incision technique for arthroscopic ACL reconstruction results in long-term knee stabilization and functioning among young active individuals while simultaneously avoiding graft harvest site morbidity. Level of Evidence: Level IV, therapeutic case series. Key Words: Anterior cruciate ligament—Arthroscopy-assisted surgery—Fresh- frozen allogeneic tendon graft—Long-term-follow-up. T he anterior cruciate ligament (ACL) injury is a common sport-related injury of the knee that re- sults in knee instability and joint deterioration over time. 1 Surgical reconstruction of the ACL is recom- mended for restoration of stability and function in patients with symptomatic ACL insufficiency. 2 Al- though reconstruction of the ACL with various types of autogenous tissue, such as hamstring tendons or a bone–patellar tendon– bone, has been reported with satisfactory outcomes, 3,4 complications of this treat- From the Department of Orthopaedics, Osaka University Grad- uate School of Medicine (K.N., Y.Ta., N.N., M.K., H.Y.), Faculty of Comprehensive Rehabilitation, Osaka Prefecture University (K.S.), Department of Orthopaedic Sports Medicine, Osaka Rosai Hospi- tal (S.H.), Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital (Y.To.), Osaka, Japan. The authors report no conflict of interest. Address correspondence and reprint requests to Ken Nakata, M.D., Ph.D., Department of Orthopaedics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565- 0871, Japan. E-mail: ken-nakata@umin.ac.jp © 2008 by the Arthroscopy Association of North America 0749-8063/08/2403-6360$34.00/0 doi:10.1016/j.arthro.2007.09.007 285 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 3 (March), 2008: pp 285-291