An Arthroscopic Second-Look Study on the Effect of Remnant Preservation on Synovialization of Bone–Patellar Tendon–Bone Allograft in Anterior Cruciate Ligament Reconstruction

Guo, Lin; Hao, Chang‐Ning; Luo, Jiangming; Yang, Liu; Gu, Lixu; Fu, Dejie

doi:10.1016/j.arthro.2015.11.017

Cited by 20 publications

(23 citation statements)

References 23 publications

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“…Tension of the ACL graft was evaluated subjectively with meticulous probing and was graded as follows: good (tautness), fair (slightly lax, but acceptable), and poor (no tension). Synovial coverage was classified as follows: covering 25% or less, 25% to 50%, 50% to 75%, and more than 75% as in previous studies 1718)…”

Section: Methodsmentioning

confidence: 99%

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

et al. 2019

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Background This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. Methods ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). Results The S group showed significantly less deep flexor strength deficit than the D group ( p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups ( p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. Conclusions The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

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Section: Methodsmentioning

confidence: 99%

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

et al. 2019

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“…The preservation of the synovium during reconstruction surgery in cases involving a Crain type 3 remnant was difficult because it was located close to the ACL femoral footprint and could easily have been damaged during the preparation of the femoral tunnel. 20 Although the patients with Crain type 3 remnants showed significantly decreased preoperative SSD values, this may be the reason why no significant difference was observed in the postoperative results.…”

Section: Discussionmentioning

confidence: 94%

The relationship between the clinical results and the remnant type following anterior cruciate ligament reconstruction using a hamstring tendon

Kimura

Hagiwara

Ogoshi

et al. 2019

J Orthop Surg (Hong Kong)

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The aim of the present study was to investigate the correlations among the preoperative and postoperative knee laxity, the clinical results, and the type of remnant tissue following the anterior cruciate ligament (ACL) reconstruction. Methods: One hundred ninety-two patients (male, n ¼ 101; female, n ¼ 91; mean age, 27.1 years) with ACLdeficient knees who had undergone double-bundle reconstruction were included. The time between injury and surgery (TBIS) was 34.7 weeks (range, 1-504 weeks). The subjects were divided into four groups according to the Crain's classifications and factors such as the age at surgery, gender, TBIS, side-to-side difference (SSD), Tegner activity score (TAS), and Lysholm score were compared. Results: The percentage of patients with ACL remnant pattern types 1, 2, 3, 4 was 19% (37 knees), 52% (101 knees), 9% (19 knees), and 18% (35 knees), respectively. The TBIS of the patients with Crain type 4 was significantly longer in comparison to the other groups (p < 0.01). A significant difference was observed in the preoperative SSD of the Crain type 3 and Crain type 4 (6.2 + 3.4 mm, 9.3 + 3.6, respectively) groups. The TBIS in patients with Crain type 4 was significantly longer in comparison to the other groups (p < 0.01). There were no significant differences between the groups in terms of the postoperative SSD, TAS, or Lysholm score. Conclusion: This study suggests that a Crain type 3 remnant was associated with a significantly lower preoperative SSD. In addition, the TBIS in patients with Crain type 4 was found to be significantly longer in comparison to the other groups.

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“…There are several studies reporting second-look findings after remnant-preserving technique. Kim et al 27 assessed 66 consecutive patients who underwent second-look arthroscopy after ACLR using a hamstring autograft and found that cases with 50% or more preserved remnant showed thicker graft tissue with better synovial converage. Guo et al 28 performed second-look arthroscopy after ACLR using a bone-patellar tendon-bone allograft, and found that patients with no remnant or lower position remanant had poorer synovium coverage.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament remnant cells have different potentials for cell differentiation based on their location

Lee

et al. 2020

Sci Rep

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Histological and cytological observations of the human anterior cruciate ligament (ACL) had been described, but the differentiation potency based on their location is still unknown. To determine and compare proliferation and differentiation potential of cells derived from distal and middle thirds of the ACL remnant, ACL remnant was initially marked at the distal third (within 10 mm from the tibial insertion) and middle third (between 10-20 mm from the tibial insertion) and then dissected. Both the middle and distal third regions of ACL remnant were analyzed using CD34 + cell counting. Cell proliferation rate did not differ in both middle and distal third regions of ACL remnant, but they showed different characteristics in cell differentiation depending on their location. The distal third region of the ACL remnant had a tendency for chondrogenic differentiation with higher expression of CD34 + cells. On the other hand, the middle third region of ACL remnant had a strong tendency for osteogenic and ligamentous differentiation. Characteristics of the ACL remnant tissues should be considered when performing remnant-preserving or harvesting ACL remnants for tissue engineering. Anterior cruciate ligament reconstruction (ACLR) is one of the most common surgical procedures in the field of orthopaedic sports medicine, with more than 130,000 procedures performed annually in the United States alone 1,2. It has been well documented that a completely ruptured ACL does not spontaneously heal because of poor vascular supply and an unfavourable intra-articular environment 3. Given the importance of its biomechanical function, surgical treatment is generally accepted as the standard procedure for restoring knee stability. In most cases, non-augmented primary repair has been unsuccessful, and therefore ACL reconstruction is required 1,4,5. For surgical success, ACLR requires tendon graft healing in a surgically created bone tunnel and maturation (i.e., ligamentization) of the graft substance 4,6-9. Indeed, the lack of vascularity within the tendon graft induces degeneration or micro ruptures during the early postoperative period 10. To overcome these issues, tissue engineering using stem cells has been widely explored as a means to achieve early graft healing, tendon regeneration, and bone integration. Recently, reports have shown that ruptured human ACL tissues can possess numerous vascular-derived stem cells and that ACL-derived CD34 + cells can promote healing and have high expansion and multilineage differentiation potential 7,11-13. Mifune et al. 14 demonstrated that ACL-derived CD34 + cells contributed to tendon-bone healing after ACLR via angiogenesis and osteogenesis enhancements 15. Furthermore, Matsumoto et al. 16 found that incorporation of ruptured ACL tissues in autologous grafts reduced tunnel enlargement in ACLR 16,17. However, with regard to their clinical application, potential advantages of remnant-derived stem cells are still questionable. Histological observations of the uninjured human ACL have shown a differe...

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An Arthroscopic Second-Look Study on the Effect of Remnant Preservation on Synovialization of Bone–Patellar Tendon–Bone Allograft in Anterior Cruciate Ligament Reconstruction

Cited by 20 publications

References 23 publications

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting

The relationship between the clinical results and the remnant type following anterior cruciate ligament reconstruction using a hamstring tendon

Anterior cruciate ligament remnant cells have different potentials for cell differentiation based on their location

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