Remnant preservation technique versus standard technique for anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials

Abstract

BackgroundThis meta-analysis was performed to compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using the ACL remnant preservation technique versus the standard technique.MethodsPubMed, Embase, and the Cochrane Library were searched through December 24, 2017, to identify randomized controlled studies that compared the use of the ACL remnant preservation technique versus the standard technique for primary ACL reconstruction. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of ACL remnant tissue (remnant bundle or remnant fibers).ResultsSeven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis. There was a significant difference between the groups in Lysholm score (mean difference (MD), 2.20; 95% confidence interval (CI), 0.95–3.45; P = 0.0006) and side-to-side difference (MD, − 0.71; 95% CI, − 0.87 to − 0.55; P < 0.01). There was no significant difference between the groups in subjective International Knee Documentation Committee (IKDC) score, complications, pivot shift test, Lachman test, or overall IKDC score. Subgroup analysis demonstrated that for primary ACL reconstruction with preservation of remnant fibers, the remnant preservation technique was superior to the standard technique based on Lysholm scores (P < 0.01) and side-to-side difference (P < 0.01).ConclusionsBased on the current literature, using the remnant preservation technique showed a better clinical outcome than using the standard technique for patients undergoing primary ACL reconstruction with respect to Lysholm score and side-to-side difference. However, it remains unclear that there is a definite advantage to use the remnant preservation technique compared with the standard technique.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0937-4) contains supplementary material, which is available to authorized users.

Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database

“…Yet some studies demonstrated similar rates of cyclops syndrome between remnant- and non–remnant preserving techniques. 3,12,26,40…”

“…Furthermore, there were no significant differences between techniques in the rate of cyclops lesions. 40 However a major limitation of this meta-analysis was that the included randomized controlled trials reporting this outcome were all small. Consequently, there was only a single case of cyclops syndrome among the pooled population, and the analysis was therefore underpowered to detect a significant difference between remnant preservation and standard techniques with respect to reoperation rates for this particular indication.…”

Combined Anterior Cruciate Ligament Primary Repair With an Autograft Reconstruction

“…To consider such an ACL repair, some criteria have to be checked, but the concept highlights the role of the remnant keeping the mechanoreceptors and saving the vascular supply 2 coming from the tibial insertion; this can lead to better graft integration and therefore better clinical results. 6 At the same time, we reported in 2018 good functional and clinical results for ACL reconstruction using 4 strands of semitendinosus autologous graft with both femoral and tibial cortical adjustable fixation. 7 Our technique allows redirection of the proximal end of the remnant, which is not usually healed in femoral ACL native insertions after ACL tear.…”

Arthroscopic Primary Repair of the Anterior Cruciate Ligament With Single-Bundle Graft Augmentation

“…On the contrary, a recent meta-analysis did not show a true clinically important difference between remnant-preserving and remnant-resecting surgery; therefore, the additional value of remnant preservation is still controversial. 14 The most common complication of remnantpreserving ACL surgery is the increased risk of reoperation for impingement as a result of cyclops lesions from the remnant sagging distally. 15 One of the main benefits of the currently described technique is that the remaining remnant is tensioned and tied over a ligament button at the lateral femoral cortex, thus preventing cyclops lesions.…”