Clinical application of modified Crain classification in the Design of Anterior Cruciate Ligament Reconstruction with remnant preservation

Abstract

Background To investigate the clinical application of modified Crain classification in anterior cruciate ligament (ACL) reconstruction (ACLR) with remnant preservation. Methods The subjects were 70 patients with ACL injury who underwent ACLR from May 2016 to June 2018, and their general data were recorded. They were randomly divided into modified remnant-preserved ACLR group (group M, n = 35) and non remnant-preserved ACLR group (group N, n = 35). ACLR program with remnant preservation was designed based on modified Crain classification in group M, while ACL remnants were completely cleaned during ACLR in group N. Subsequently, the two groups were compared in terms of operation time, complications, as well as Lysholm score, international knee documentation committee (IKDC) score and positive rate of Lachman test of knee joint before operation and at 3, 6 and 12 months after operation. Results Both the groups showed good postoperative efficacy, and none had complications like limited knee extension or cyclops lesion. The comparison results found that group M (72.49 ± 7.64 min) required longer operation time than group N (66.06 ± 6.37 min) (P < 0.05). Lysholm score and IKDC score at 3, 6 and 12 months after operation in the two groups were significantly higher than those before operation (P < 0.05); group M had higher Lysholm score and IKDC score at 3 months and 6 months after operation compared with group N (P < 0.05). Additionally, the positive rate of Lachman test at 3, 6 and 12 months after operation in both groups was significantly lower than that before operation (P < 0.05), but there was no significant difference between group M and group N. Conclusion With the modified Crain classification, many remnant-preserved reconstruction techniques can be rationally used to completely preserve the remnant ligament tissue during operation and improve knee joint function and joint stability with few complications.

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

“…8,19,22 Additionally, the ASP technique has shown benefits in retaining proprioceptors on the synovium of residual ligamentous tissue, accelerating the recovery of neuromuscular control and knee function, 1,7 maintaining the stability of the knee joint and decreasing the mechanical load on the graft, 9,14,25 and hastening biological healing of the graft by enhancing cell proliferation and revascularization . 24-26,29 Moreover, owing to the presence of functional cells in the remnants, tunnel widening, which is thought to result from synovial fluid egress, can be prevented. 17,30…”

“…8,19,22 Additionally, the ASP technique has shown benefits in retaining proprioceptors on the synovium of residual ligamentous tissue, accelerating the recovery of neuromuscular control and knee function, 1,7 maintaining the stability of the knee joint and decreasing the mechanical load on the graft, 9,14,25 and hastening biological healing of the graft by enhancing cell proliferation and revascularization . [24][25][26]29 Moreover, owing to the presence of functional cells in the remnants, tunnel widening, which is thought to result from synovial fluid egress, can be prevented. 17,30 Both techniques showed a standard deviation less than what was reported by anatomic studies (AP: ASP = 2.9%, TSP = 3.0%, anatomic = 11.1%; ML: ASP = 2.0%, TSP = 2.2%, anatomic = 3.2%), implying that they can reflect the natural variation among individual patients without increasing the deviation in positioning.…”