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�Web references

[Posted as supplied by the authors]

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w2. Aglietti P, Zaccherotti G, Buzzi R, De Biase P. A comparison between patellar tendon and double semitendinosus/gracilis tendon for anterior cruciate ligament reconstruction. A minimum five-year follow-up. Journal of Sports Traumatology.& Related.Research. 1997;19:57-68.

w3. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: Bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts - A prospective, randomized clinical trial. Journal of Bone and Joint Surgery-American Volume 2004;86A(10):2143-2155.

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Appendix 1: Clinical tests assessing the anterior cruciate ligament

[Posted as supplied by the authors]

The lachman test¹²:

This test reproduces the anterior tibial displacement in relation to the femur with the knee at 15 degrees of flexion. It is reported as negative (hard end point) when the anterior cruciate ligament is intact, and positive when there is proprioceptive or visual anterior translation of the tibia relative to the femur with a characteristic soft end point. It has shown fair sensitivity and specificity in diagnosing an anterior cruciate ligament rupture

The pivot shift test¹²:

This test reproduces the anterior tibial translation of the tibial plateau in relation to the femoral condyle when the knee approaches extension with reduction produced with knee flexion. This test has a high specificity.

The instrumented measurement of knee laxity:

This test measures the anterior tibial displacement in relation to the femur with the knee at 15 degrees of flexion with the aid of an arthrometer at various forces (from 89N to manual maximum). It is reported as the difference in millimetres between the measures of the normal contralateral side minus the measure of the evaluated side.

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Appendix 2: Questions assessing the quality of randomized controlled trials

[Posted as supplied by the authors]

Was the randomisation process described and appropriate?
Was the withdrawal/drop-out rate described and acceptable (<20%)?
Were co-interventions comparable?
Was the assessment independent?
Were the main outcomes analysed according to the intention to treat principle?

One point is given for each positive answer. Studies are rated as poor for a total ≤ 2, fair for a total of 3 or 4, and good if all questions have been answered.