Comparison of second-look arthroscopic findings and clinical results according to the amount of preserved remnant in anterior cruciate ligament reconstruction

Kim, Min Kyu; Lee, Sung Rak; Ha, Jeong Ku; Jong, Ho; Kim, Sang Bum; Kim, Jin Goo

doi:10.1016/j.knee.2014.02.011

Cited by 41 publications

(37 citation statements)

References 19 publications

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“…First, this study dealt with ACL reconstruction with remnant preservation using BPTB autograft. To the best of our knowledge, all of the grafts used in previous studies related to ACL reconstruction with remnant preservation were hamstring autografts, 9,10,13,14 and no published study has yet described the outcomes of ACL reconstruction with remnant preservation using BPTB autograft. Depending on the type of grafts used, the processes for graft healing are divided into either bone-to-bone healing or tendon-bone healing.…”

Section: Discussionmentioning

confidence: 99%

“…12 Most previous studies focusing on remnant preservation have addressed ACL reconstruction using hamstring graft. 9,10,13,14 To the best of our knowledge, there has been no previous study dealing with ACL reconstruction using bone-patellar tendon-bone (BPTB) autograft with remnant preservation. The purpose of the current study was to compare the clinical outcomes between groups of patients who underwent ACL reconstruction by using BPTB autograft divided according to the amount of ACL remnant, as well as to investigate the effect of remnant preservation on outcomes of ACL reconstruction.…”

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confidence: 99%

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Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue

et al. 2018

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There has been controversy about whether remnant tissue of anterior cruciate ligament (ACL) has to be preserved in ACL reconstruction. The purpose of the study was to compare clinical outcomes between groups of patients who underwent ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft divided according to amount of ACL remnant and investigate effect of remnant preservation on outcomes of ACL reconstruction. A total of 185 patients who underwent ACL reconstruction with BPTB autograft were retrospectively reviewed. Patients were divided into four groups according to proportion of length of remnant tissue of injured ACL covering part of reconstructed ACL to total length of reconstructed ACL: group A included 83 patients with no remnant, group B consisted of 38 patients with remnant of < 1/3, group C consisted of 35 patients with remnant of 1/3 to2/3, and group D consisted of 29 patients with remnant of > 2/3. Primary outcome was International Knee Documentation Committee (IKDC) subjective score. Secondary outcomes were stability, range of motion, patient-reported outcomes determined by Lysholm knee scoring scale and Tegner activity scale, IKDC objective grade, and single hop for distance. Return to activity and near-return to activity were investigated. A minimum follow-up duration was 24 months. There was no statistically significant difference between four groups regarding postoperative anterior translation ( = 0.731), Lysholm knee score ( = 0.599), IKDC objective grade ( > 0.999), hop test ( = 0.878), and near-return to activity ( = 0.193). However, patients of group D had significantly better outcomes in IKDC subjective score (group A = 85.0 ± 5.9, group B = 84.9 ± 8.1, group C = 87.4 ± 6.4, group D = 89.2 ± 8.1, = 0.017), Tegner activity scale (group A = 5.0 ± 1.1, group B = 5.2 ± 1.0, group C = 5.7 ± 1.3, group D = 5.9 ± 1.0, = 0.001), and return to activity (group A = 25.3%, group B = 31.6%, group C = 45.7%, group D = 55.2%, = 0.014). ACL reconstruction using BPTB autograft with remnant preservation did not provide better anterior stability compared with conventional ACL reconstruction. However, preservation of remnant of> 2/3 led to more improved activity-related clinical outcomes than no remnant preservation. In cases with substantial remnant tissue of injured ACL remaining, reconstruction of ACL while preserving as much remnant tissue as possible is recommended. This is a Level III, retrospective comparative therapeutic study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue

et al. 2018

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“…67 However, it should be noted that there was a large difference in the interval from injury to reconstruction between the two groups (7.3 versus 16.3 months). 67 Finally, Kim et al (66 patients) found statistically significant increases in graft hypertrophy and synovialization, on second-look arthroscopy, combined with increases in clinical outcomes (IKDC and Lysholm scores) in the remnant-preservation group 68 and Muneta et al (88 cases) showed a weak correlation between remnant volume and postoperative outcome (both objective stability and subjective recovery). 69 Contrary to this, two prospective studies have found no improvement with remnant-preservation.…”

Section: Remnant-preservation Acl Reconstructionmentioning

confidence: 96%

Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings

Kosy

Mandalia

2017

J Knee Surg

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Mechanoreceptors, within the anterior cruciate ligament (ACL), are believed to have importance in proprioception, contributing to dynamic knee stability. The potential for reinnervation of the ACL graft is one of the proposed advantages of remnant-preserving reconstruction. The aim of this review is to summarize advances in the basic science underpinning this function, alongside recent clinical studies, to define the current role for remnant-preservation.A comprehensive systematic review was performed using PubMed and Medline searches. Studies were analyzed with particular focus placed on the methodology used to either identify mechanoreceptors or test proprioception.Contemporary work, using immunohistological staining, has shown mechanoreceptors primarily within proximity to the bony attachments of the ACL (peripherally in the subsynovial layer). The number of these receptors has been shown to decrease rapidly, following rupture, with adhesion to the posterior cruciate ligament slowing this decline. Recent studies have shown proprioceptive deficits, in both the injured and contralateral knees, with the clinical relevance of findings limited by testing methodology and the small differences found. The advantages of remnant-preservation, seen primarily in animal studies, have not been shown in systematic reviews or meta-analysis of clinical studies.The potential for reinnervation of the graft is likely time-dependent and reliant on continued loading of the remnant. Therefore, current clinical use and future research should focus on preserving remnants within 6 months of injury that remain loaded by adherence to the posterior cruciate ligament. Subsequent testing should account for central neurological changes and focus on clinically relevant outcomes.

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“…In clinical setting, several investigators have developed ACL reconstructions with remnant tissue preservation, reporting better clinical outcomes. [18][19][20][21][22][23][24][25][26][27] However, the effects of remnant preservation remain controversial [28][29][30][31] (►Table 2).…”

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The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation

et al. 2018

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Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, = 43) or without (Group N, = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (-0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) ( = 0.019), as well as in the Group N patients ( = 0.019). The degree of synovial coverage of the anteromedial ( = 0.0064) and posterolateral ( = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal ( = 0.049), middle, and distal ( = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.

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Comparison of second-look arthroscopic findings and clinical results according to the amount of preserved remnant in anterior cruciate ligament reconstruction

Cited by 41 publications

References 19 publications

Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue

Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue

Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings

The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation

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