Comparative Study of Graft Healing in 2 Years after “Tension Suspension” Remnant-Preserving and Non-Remnant-Preserving Anatomical Reconstruction for Sherman Type II Anterior Cruciate Ligament Injury

Abstract

Purpose: To evaluate the degree of graft healing after “tension suspension” reconstruction of “Sherman II” anterior cruciate ligament injuries versus non-remnant preserving anatomical reconstruction and to compare the clinical outcomes of the two procedures. Method: The clinical data of 64 patients were retrospectively included. There were 31 cases in the “tension suspension” remnant-preserving reconstruction group and 33 cases in the non-remnant-preserving anatomical reconstruction group. The International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm activity score were assessed preoperatively and at 6 months, 1 year, and 2 years postoperatively, respectively. The signal/noise quotient (SNQ) of the grafts was measured at 6 months, 1 year, and 2 years after surgery to quantitatively evaluate the maturity of the grafts after ACL reconstruction; the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the reconstructed ACL region of interest (ROI) were measured using DTI. Result: A total of 64 patients were included in the study. The mean SNQ values of the grafts in the 6 months, 1 year, and 2 years postoperative remnant-preserving reconstruction (RP) groups were lower than those in the non-remnant-preserving (NRP) reconstruction group, with a statistically significant difference (p < 0.05). At each postoperative follow-up, the SNQ values of the tibial and femoral sides of the RP group were lower than those of the NRP group; the SNQ values of the femoral side of the grafts in both groups were higher than those of the tibial side, and the differences were statistically significant (p < 0.05). At 6 months, 1 year, and 2 years postoperatively, the FA and ADC values of the grafts were lower in the RP group than in the NRP group, and the differences were statistically significant (p < 0.05); the IKDC score and Lysholm score of the RP group were higher than the NRP group, which was statistically significant (p < 0.05). Conclusion: For Sherman II ACL injury, the graft healing including ligamentization and revascularization at 2 years after the “tension suspension” remnant-preserving reconstruction was better than that of non-remnant-preserving anatomic reconstruction.

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant‐preserving anterior cruciate ligament reconstruction

“…More precisely, several surgical approaches for femoral tunnel positioning during remnant‐preserving ACLR have been proposed: some articles used intraoperative fluoroscopy [33]; some used the lateral intercondylar ridge (LIR) as a landmark [37]; and some used the remnant itself to locate the femoral tunnel [12]. Although all of the above methods could effectively create the femoral tunnel while preserving remnants [11], several studies still showed that the remnant could affect the accuracy of femoral tunnel positioning [1, 18].…”