Anterior Cruciate Ligament Reconstruction Using Remnant Preservation and a Femoral Tensioning Technique: Clinical and Magnetic Resonance Imaging Results

Ahn, Jin Hwan; Wang, Joon Ho; Lee, Yong Seuk; Kim, Jae Gyoon; Kang, Jun Hee; Koh, Kyoung Hwan

doi:10.1016/j.arthro.2011.03.002

Cited by 105 publications

(117 citation statements)

References 42 publications

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“…[14][15][16][17] Therefore it seems reasonable to assume that the remnant tissue could be preserved, especially the tibial side, as a source of reinnervation if impingement and cyclops lesions can be prevented. 1,4,5,18 However, during remnant preservation, using an anterior portal could interfere with restoration of the anatomic footprint because remnant tissue could be an obstacle to formation of an anatomic tunnel location.…”

Section: Discussionmentioning

confidence: 99%

“…5,[22][23][24] The TightRope device is included among cortical suspension devices and has acceptable biomechanical properties. [25][26][27] This device is commonly used with a FlipCutter during outside-in femoral drilling; the FlipCutter has been newly devised and achieves the least invasive bone-sparing reconstructive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Good results have been reported after remnantpreserving ACL reconstruction using a transtibial technique. 4,5 However, another important point to consider is an anatomic reconstruction at the footprint of the native ACL. [6][7][8][9][10] After remnant-preserving ACL reconstruction, the position of the femoral tunnel was not satisfactory and it was supposed to be positioned slightly to the anterior side, compared with our expectation, even though good clinical results were achieved.…”

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confidence: 99%

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Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Ahn

Lee

2014

Arthroscopy Techniques

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We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70 arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Ahn

Lee

2014

Arthroscopy Techniques

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“…This kind of ACL-remnant preservation with isolated bundle reconstruction is gaining recognition in the orthopaedic community. In fact, several authors have demonstrated clinical outcomes equal to those of standard ACL reconstruction with the use of remnant preservation/isolated bundle reconstructions [1,2,6]. Identifying these isolated/ partial ACL tears can be difficult, not only on clinical examination, but also by MRI.…”

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confidence: 99%

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

Levy

2013

Clinical Orthopaedics &Amp; Related Research

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“…4 However, ACL remnanteretaining procedures can be technically demanding and predispose to cyclops lesion formation. 5 The purpose of this study is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur using a "lasso loop" reeved through the femoral EndoButton (EndoButton CL; Smith & Nephew Endoscopy, Andover, MA). 6 …”

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confidence: 99%

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Boutsiadis

Karampalis

Tzavelas

et al. 2015

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnantesparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device.A nterior cruciate ligament (ACL) rupture is one of the most common knee injuries, predisposing to altered knee kinematics, loss of neuromuscular feedback, increased medial compartment contact, and shear forces. 1,2 In an effort to decelerate this degenerative process, arthroscopic anterior cruciate ligament reconstruction (ACLR) using tendon autografts has been one of the most popular surgical interventions worldwide. 3 However, despite the numerous surgical techniques described, ACLR improves the patient's activity level and reduces, but does not eliminate, the risk of joint degeneration and the necessity for further surgery. 2,3 Restoration of normal ACL anatomy requires anatomic remodeling, fiber maturation, and ligamentization of the applied graft. Early ACL remnantesparing techniques support the theory of preserving the proprioceptive receptors, enhancing the revascularization process, and finally, achieving "cellular ligamentization." 4 However, ACL remnanteretaining procedures can be technically demanding and predispose to cyclops lesion formation. 5 The purpose of this study is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur using a "lasso loop" reeved through the femoral EndoButton (EndoButton CL; Smith & Nephew Endoscopy, Andover, MA). 6 Surgical Technique Joint Assessment and Graft PreparationThe patient is positioned supine with a thigh tourniquet and a standard leg holder allowing full knee range of motion. With a 4.0-mm 30 arthroscope, standard anterolateral and anteromedial (AM) portals are made. The knee joint is evaluated, and other associated lesions are assessed and addressed appropriately. The ACL tear i...

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Anterior Cruciate Ligament Reconstruction Using Remnant Preservation and a Femoral Tensioning Technique: Clinical and Magnetic Resonance Imaging Results

Cited by 105 publications

References 42 publications

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

CORR Insights®: How Useful is MRI in Diagnosing Isolated Bundle ACL Injuries?

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

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