Effects of Remnant Tissue Preservation on the Tendon Graft in Anterior Cruciate Ligament Reconstruction

Takahashi, Tsuneari; Kondo, Eiji; Yasuda, Kazunori; Miyatake, Shin; Kawaguchi, Yasuyuki; Onodera, Jun; Kitamura, Nobuto

doi:10.1177/0363546516643809

Cited by 70 publications

(90 citation statements)

References 40 publications

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“…58 Healing has been shown to occur, between the remnant and the graft, (between 4 and 12 weeks postreconstruction in a sheep model) with remnant-preservation resulting in both accelerated revascularization and increased MRCs after this time point. 59 Other improvements have been recorded in terms of a thicker synovium (and graft crosssectional area), a wider attachment to the tibia, increased density of blood vessels, and a smaller avascular zone in the center of the graft. 59 Furthermore, Fu et al showed the presence of mesenchymal stem cells, 60 Xie et al found an increase in mRNA expression (associated with angiogenesis and nerve growth), 61 and Trocan et al found the presence of CD-34 positive fibroblasts (required for angiogenesis) within the ACL remnant.…”

Section: Remnant-preservation Acl Reconstructionmentioning

confidence: 99%

“…59 Other improvements have been recorded in terms of a thicker synovium (and graft crosssectional area), a wider attachment to the tibia, increased density of blood vessels, and a smaller avascular zone in the center of the graft. 59 Furthermore, Fu et al showed the presence of mesenchymal stem cells, 60 Xie et al found an increase in mRNA expression (associated with angiogenesis and nerve growth), 61 and Trocan et al found the presence of CD-34 positive fibroblasts (required for angiogenesis) within the ACL remnant. 62 Following on from the research covered in the previous section, work (in a sheep model) has demonstrated that adhesion of the remnant to the graft prevents degeneration of neural elements by retensioning this tissue.…”

Section: Remnant-preservation Acl Reconstructionmentioning

confidence: 99%

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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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Section: Remnant-preservation Acl Reconstructionmentioning

confidence: 99%

Section: Remnant-preservation Acl Reconstructionmentioning

confidence: 99%

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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“…Remnant-preserved ACL reconstruction is gaining popularity because the remnant-preservation effect may have the advantages of synovial coverage of the graft, graft remodeling, proprioceptive recovery, stability, and better clinical outcomes, [14][15][16]29 although controversial reports exist. 30,31 However, most remnant-preserved ACL reconstructions do not repair the remnant.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, remnant-preserved anterior cruciate ligament (ACL) reconstruction has gained popularity because the remnant-preservation effect may be advantageous for graft remodeling, proprioceptive recovery, and clinical outcomes. [14][15][16] We describe the technique of anatomical arthroscopic ATFL repair and reconstruction (AAARR) using a free tendon graft, which has the possible advantages of not only remnant preservation but also sharing of the ligament load by the repaired ATFL remnant and the reconstructed ATFL graft. A summary of the key steps is provided in Table 1, and a summary of the technique is shown in Video 1.…”

mentioning

confidence: 99%

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.

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“…к тому же с увеличением вре-мени после травмы происходит его дальнейшее уменьшение [15]. В связи с этим такая тактика может быть перспективной в основном для па-циентов молодого возраста в ранние сроки после травмы [10,16]. однако это положение оспари-вается M.S.…”

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Modern Trends in Surgical Treatment of Patients With Acl Ruptures (Literature Review)

Rikun

Хоминец

Федотов

2017

Traumatology and Orthopedics of Russia

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The authors conducted an analysis of national and foreign scientific publications dedicated to the problems in treatment of patients with ruptures of the anterior cruciate ligament of the knee joint. The results of the analysis demonstrated that such lesions still remain the key knee pathology resulting from sports injuries that significantly affect knee function and require timely reconstructive surgical correction. Based on the study the key areas of improvement in treatment for mentioned category of patients have been identified. This is the biomechanically justified single bundle anatomical ACL reconstruction which is currently widely applied in the clinical practice by using of an isometrically located autograft. Such technique represents a radically new stage in the development of treatment methods for young and middle-aged patients with high functional demands.

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Effects of Remnant Tissue Preservation on the Tendon Graft in Anterior Cruciate Ligament Reconstruction

Abstract: These results imply that preservation of the ACL remnant tissue may improve graft healing after ACL reconstruction.

Cited by 70 publications

References 40 publications

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

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

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Modern Trends in Surgical Treatment of Patients With Acl Ruptures (Literature Review)

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